West Bengal Health Scheme 2008

WEST BENGAL HEALTH SCHEME, 2008Government of West Bengal Finance Department Medical Cell, Writers’ Buildings Kolkata - 700 001 CONTENTS Sl. No. 1. Order No. Notification no. 7287 Dt. 19.09.2008 Notification no. 3472-F Dt. 11.05.2009 Notification no. 3473-F Dt. 11.05.2009 Notification no. 3473-F Dt. 11.05.2009 Notification no. 3473-F Dt. 11.05.2009 Notification no. 3473-F Dt. 11.05.2009 Memo No. 3474-F dt. 11.05.2009 Memo no. 3475-F dt. 11.05.2009 Subject West Bengal Health Scheme, 2008 Appointed date of WBHS, 2008 Page No.s 1-15 2. 16 3. List of recognized hospitals within and outside the State Amendment of Clause-8 of WBHS, 2008 List of Private Hospitals 17-18 4. 18 5. 19-21 6. Approved rates 22-48 7. Operational guideline on WBHS, 2008 Extension of the benefits of West Bengal Health Scheme to the State Government Pensioners Memorandum of Agreement (MOA) 49-54 8. 55-69 9. ___________ 70-84 PART I] Registered THE KOLKATA 1 No. WB/SC-247 GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 No. WB(Part-I)/2008/SAR-332 The Kolkata Extraordinary Published by Authority BHADRA 28] FRIDAY, SEPTEMBER 19, 2008 [SAKA 1930 Gazette PART I—Orders and Notifications by the Governor of West Bengal, the High Court, Government Treasury, etc. GOVERNMENT OF WEST BENGAL FINANCE DEPARTMENT AUDIT BRANCH NOTIFICATION No. 7287–F 19-09-2008—The Governor is pleased hereby to make, in addition to the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended, the following scheme regulating the medical benefits for the State Government employees and the family members thereto, with a view to providing better medical facilities to such employees and their family members :— Scheme 1. 2008. Short title and commencement — (1) This Scheme may be called the West Bengal Health Scheme, (2) It shall come into force on such date, as the State Government may, by notification in the Official Gazette, appoint. 2. Application— (1) This scheme shall apply to the employee and his beneficiary. (2) The provision of enrolment under this scheme shall be optional. (3) An employee shall not be entitled to draw the regular medical allowance with effect from the date of effect of such enrolment under clause 4. (4) An employee and his beneficiary shall be entitled to the facilities under this scheme in addition to the facilities under the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended. 2 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (5) An employee shall have the liberty to opt out of this scheme at any time. Provided that where an employee or his beneficiary has enjoyed any benefit under this scheme, such employee shall not be allowed to opt out the scheme within five years from the month following the month in which he enjoyed the benefit. 3. Definitions — In this Scheme, unless there is anything repugnant in the subject or context– (a) “approved rates” means such rates as may be notified by the Government from time to time for various services, procedures and investigations required in connection with the medical attendance and treatment of a beneficiary; “beneficiary” means a member of the family of an employee; “clause” means a clause of the scheme; “employee” means an employee of the Government of West Bengal enrolled under clause 4; “family”, in relation to an employee, means— (i) children including step-children and unmarried daughters, (b) (c) (d) (e) (ii) minor brothers, (iii) minor sisters, (iv) father or mother whose monthly income does not exceed rupees one thousand five hundred, (v) wife or husband, as the case may be; (f) (g) (h) “Form” means a Form appended to this scheme; “Government” means Government of West Bengal; “hospital or institution” means such hospital or nursing home or institution as may be recognized from time to time by the Government for the purpose of availing benefits of medical attendance and treatment under this scheme; “laboratory” means such laboratory or institution as may be recognized by the Government from time to time for availing of benefits of medical attendance and treatment under this scheme; “medical attendance” means attendance for professional advice and includes pathological, bacteriological, radiological or other methods of investigations for the purpose of diagnosis which are considered necessary by the attending physician and are carried out in a hospital or institution; “specified” means specified by order; “treatment” means the use of medical and surgical facilities and includes– (i) the employment of such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician; (i) (j) (k) (l) (ii) the use of such medicines, vaccines, serum or other therapeutic substances as may be considered necessary by the attending physician; (iii) medical and surgical services and procedures; (iv) dental treatment; (v) accommodation according to the entitlement of the employee; PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 3 (vi) such nursing as is ordinarily provided at the hospital or such special nursing at the hospital as the authorized medical attending physician at the hospital may certify, in writing, to be essential for the recovery or for the prevention of serious deterioration in the condition of the patient, having regard to the nature of the disease. 4. Enrolment – (1) An employee seeking enrolment under the scheme shall exercise his option in Form A, in duplicate, along with an undertaking that upon enrolment under this scheme, such employee shall forgo the regular medical allowance drawn as part of monthly salary. (2) The option referred to in sub-clause (1) shall be submitted– (a) and (b) to the Head of Office, in case of any other employee. to the Cadre Controlling Department, in case an employee is a member of a constituted State service; (3) The Cadre Controlling Authority or the Head of Office, as the case may be, shall, after scrutinization of the option exercised by the employee, issue a certificate of enrolment in Form B in favor of the employee, to be effective from the first day of the month following the month in which the certificate is issued. (4) The Cadre Controlling Authority or the Head of Office, as the case may be, shall send one copy of the certificate to the Drawing and Disbursing Officer in respect of the employee with a direction to discontinue the drawal of regular medical allowance with effect from the first day of the month following the month in which the certificate is issued. 5. Facilities – An employee or a beneficiary of such employee shall be entitled to the following facilities, namely:– (a) (b) medical attendance and treatment as an indoor patient in a hospital or an institution; and medical attendance and treatment at out patient department of a hospital or an institution, or a clinic attached to such hospital or institution for such diseases, and under such circumstances, as may be specified. 6. Medical attendance and treatment as an indoor patient in a hospital – An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment, as an indoor patient in a hospital or an institution. Explanation.– For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include – (a) (b) (c) the amount charged by the hospital or institution in accordance with the approved rates; the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution; the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out, on the advice of the attending physician, in a laboratory or institution, other than the hospital or institution in which the patient is treated. 7. Medical attendance and treatment as an OPD (Out-Patient Department) patient in a hospital – (1) An employee shall be entitled to reimbursement of the cost of his or his beneficiary’s medical attendance and treatment as an OPD patient in a hospital or institution in the following cases : – (i) Malignant diseases, (ii) Tuberculosis, 4 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (iii) Hepatitis B/C and other liver diseases, (iv) Insulin-dependent diabetes, (v) Heart diseases, (vi) Neurological disorders/Cerebrovascular disorders, (vii) Malignant malaria, (viii) Renal failure, (ix) Thallasaemia/Bleeding orders/Platelet disorders, (x) Injuries caused by accidents. (2) An employee or his beneficiary shall also be entitled to reimbursement of the cost of follow-up medical attendance and treatment relating to Neuro Surgery, Cardiac Surgery (Including Coronary Angioplasty and implants), Cancer Surgery/Chemotherapy/Radiotherapy, Renal Transplant, Hip/Knee replacement Surgery and Accident cases received as an OPD patient in a hospital or institution. Explanation. – For the purpose of this clause, the expression “cost of medical attendance and treatment” shall include– (a) (b) (c) the amount charged by the hospital or institution in accordance with the approved rates, the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution. the charges for such pathological, bacteriological, radiological or other methods of investigations as are considered necessary by the attending physician and carried out on the advice of the attending physician in a laboratory or institution, other than the hospital or institution in which the patient is treated. 8. Accommodation– (1) In the case of medical attendance and treatment as an indoor patient in a hospital or an institution, an employee or his beneficiary shall be entitled to such accommodation as mentioned in column (4) of the Table below, of the category of the employee as mentioned in column (2), to be determined on the basis of the basic pay including dearness pay as mentioned in column (3), respectively, against the Sl. No. as mentioned in column (1) of the said Table :– Table Sl. No. (1) 1. Category of employee (2) I Basic pay including dearness pay (3) Above Rs. 18,000 p.m. Type of accommodation (4) Private Ward 2. II Rs. 12,000 p.m. and above but below Rs. 18,000 p.m. Semi-Private Ward 3. III Below Rs. 12,000 p.m. General Ward PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 5 (2) Where the type of accommodation in a hospital does not correspond to the nomenclature as referred to in column (4) of Table to sub-clause (1) or any similar nomenclature, the Government shall, in consultation with the authorities of the hospital concerned, determine the entitlement of the beneficiary. 9. Tenure – Notwithstanding anything contained in this scheme and without prejudice to the provisions of sub-clause (2) of clause 7, the cost incurred on account of related medical attendance and treatment received in a hospital or an institution during the period upto 30 days prior to hospitalization and 30 days from the date of discharge, shall be reimbursable. 10. Issue of Identity Card to employee and beneficiary – (1) The employee and his beneficiary shall be issued a photo-identity card with a unique identification number under the seal and signature of the issuing authority. (2) The identification number of the employee and his beneficiary shall consist of three numbers, for example x/y/z, where “x” denotes the code number of the employee, “y” denotes the serial number of the beneficiary belonging to the family of the employee (it being 1 in the case of the employee himself) and “z” denotes the total number of cards issued for the family of the employee. Explanation.– For the purpose of this clause, the expression “issuing authority” shall mean– (a) and (b) the Head of Office, in case of any other employee. the Cadre Controlling Department, in case an employee is a member of a constituted State service; (3) The blank identity cards with running serial numbers shall be supplied by the Finance Department on the basis of requisition received from the Cadre Controlling Departments, or the Heads of Offices through the administrative departments concerned, as the case may be. (4) The identity card shall consist of two parts of which the issuing authority shall retain the first part and the second part shall be handed over to the employee concerned. (5) A list of employees to whom identity cards have been issued shall be forwarded to the Drawing and Disbursing Officer and also to the Finance Department. (6) The identity card shall have a standard format and shall contain such particulars as the name, the date of birth and the relationship of the beneficiary with the employee. (7) The colour of the identity card shall be– (a) (b) (c) yellow, in case employee belonging to category I as mentioned in column (2) against Sl. 1 in column (1) of Table to clause 8; pink, in case employees belonging to category II as mentioned in column (2) against Sl. 2 in column (1) of Table to clause 8; and white, in case employees belonging to category III as mentioned in column (2) against Sl. 3 in column (1) of Table to clause 8. (8) For the purpose of availing the benefits under this scheme, the employee or his beneficiary shall show his identity card to the hospital, laboratory or institution where he receives medical attendance and treatment. (9) A temporary family permit in Form F may be issued to an employee enrolled under this scheme by the Head of office for a period as may be specified, pending issue of photo-identity cards and such temporary family permit shall entitle the employee and his beneficiary to all the benefits of this scheme. 6 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (10) The identity cards issued under this scheme shall be surrendered to the Cadre Controlling Department, or the Head of Office, as the case may be, at the time of retirement/resignation/on being relieved from Government service. 11. Intimation of medical attendance and treatment– An employee shall give an intimation to the Head of office within three days of commencement of his or his beneficiary’s medical attendance and treatment : Provided that where an employee himself is undergoing medical attendance or treatment and not in a position to intimate personally, any member of his family may give such intimation. 12. Claims for reimbursement of the cost of medical attendance and treatment – (1) An application for reimbursement of the cost of medical attendance and treatment shall be made by an employee in Form C. (2) The application for settlement of claim under this scheme shall be made within three months of the completion of treatment – (a) (b) (c) to the Secretary of the Department, in case of an employee working in the Secretariat, to the head of the Directorate, in case of an employee working in the headquarters of a Directorate, to the Head of Office, in all other cases. (3) The application referred to in sub-clause (1) shall be accompanied with the following documents :– (a) (b) essentiality Certificates in Form D; photocopy of the identity card issued to the employee, and where the claim relates to a member of the family of the employee, photocopy of the identity card issued to such member of the family of the employee; all original bills verified by the hospital, laboratory or institution; all original vouchers, cash memos and money receipts; detailed lists of all medicines, laboratory tests, investigations, procedures, number of doctors’ visits, etc. with dates, duly countersigned by an authorized person of the hospital where the beneficiary has received medical attendance and treatment, along with a certificate from such authorized person that all charges are as per approved rates. In the bill prepared by the hospital, each service, procedure and investigation for which the beneficiary is charged should be specified, along with this reference number in the approved list; detailed list of all medicines purchased from outside and all laboratory tests, investigations and procedures done in a laboratory, institution or hospital other than the hospital where the patient has received medical attendance and treatment, along with a certificate from an authorized person of the hospital that such medicines had to be purchased or such laboratory tests, investigations and procedures had to be done on the advice of the attending physician of the hospital; photocopy of the intimation given to the Head of the Office of the employee regarding medical attendance and treatment of the employee or the beneficiary member of the family of the employee; Check List in Form E. (c) (d) (e) (f) (g) (h) 13. Settlement of claims– (1) The application made under sub-clause (1) of clause 12 for reimbursement shall be processed by the concerned Department, the Directorate or the Office, as the case may be, under which the employee is presently working and the admissible cost of medical attendance and treatment shall be worked out on the basis of the approved rates. PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 7 (2) The sanctioning authority for reimbursement of the cost of medical attendance and treatment in the case of an employee working in the Secretariat shall be the Secretary: Provided that the Secretary may delegate this power to a Special Secretary, or a Head of Department not below the rank of Special Secretary to the Government, subject to the limits of – (i) for medical attendance and treatment as an indoor patient in a hospital, Rs. 50,000, (ii) for medical attendance and treatment as an OPD patient in a hospital, Rs. 5,000. (3) The sanctioning authority in the case of an employee working in the headquarters of a Directorate shall be the Head of the Directorate, where the claim does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 in case of OPD treatment, and the Secretary of the Department where the claim exceeds these limits. (4) The sanctioning authority in case of all other employees shall be the head of Office where the claim does not exceed Rs. 30,000 for indoor treatment and Rs. 3,000 for OPD treatment, the Head of the Directorate where the claim exceeds these limits but does not exceed Rs. 50,000 for indoor treatment and Rs. 5,000 for OPD treatment, and the Secretary of the department in all other cases. 14. Treatment in a hospital or institution outside the State– (1) Notwithstanding anything contained elsewhere in this scheme, the Government may recognize specialized hospitals and institution outside the State for treatment of specific diseases. (2) Prior approval of the Secretary of the department shall be obtained before receiving medical attendance and treatment in these hospitals or institutions. (3) Claim for reimbursement of the cost of medical attendance and treatment in these hospitals or institutions shall be allowed on the basis of the rates of various services provided by and investigations and procedures carried out by these hospitals/institutions in the course of medical attendance and treatment. 15. Medical advance– (1) The sanctioning authority for reimbursement of the cost of medical attendance and treatment may grant medical advance on submission of a certificate estimate from the hospital in which medical attendance and treatment is received as an indoor patient. (2) The Advance shall not exceed 80 per cent of the estimated cost of medical attendance and treatment. (3) The medical advance shall be adjusted against the admissible cost of medical attendance and treatment, excess, if any, shall be refunded by the employee. If medical attendance and treatment is not received within 60 days of receipt of medical advance, the entire advance shall be refunded by the employee on the expiry of this period. 16. Applicability of benefit of Scheme to retired Government employees and their family members– The benefit of the Scheme shall be applicable for the retired State Government employees and their family members, to such extent and on such terms and conditions as may be specified. 17. Operational guidelines, clarifications, etc.– (1) The Finance Department, in consultation with the Health and Family Welfare Department wherever necessary, shall issue operational guidelines, clarifications, etc. for implementation of the scheme. (2) If any difficulty arises in the course of implementation of the scheme, it shall be referred to the Finance Department and the decision of the Finance Department thereon shall be final. 8 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I FORM A Application for enrolment (See sub-clause (1) of clause 4) To The ....................................................................(Cadre Controlling Authority/Head of Office) Sir, I, Shri/Smt .......................................................(designation)......................................attached to ..............................(office) under .......................................................(Department) do hereby opt for coming under the West Bengal Health Scheme, 2008, with effect from ......................... The particulars of the members of my family as defined in para 3(e) of the Scheme are as follows : Name of Government employee Designation Residential address Date of birth Date of entry into Government service Date of superannuation Present pay (Basic + Dearness Pay) Details of Family Sl. No. Name Age Relationship Monthly income, if any 1. 2. 3. 4. 5. I do hereby declare that upon enrolment under the above scheme I shall forgo the regular medical allowance drawn by me as part of salary. I further declare that I shall abide by the provisions of the West Bengal Health Scheme, 2008, as may be in force from time to time. : : : : : : : Signature of the Applicant PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 9 FORM B Certificate of enrolment (See sub-clause (3) of clause 4) Certified that Shri/Smt ............................................................(designation) attached to .................. ............. .................................................(office) under......................................................................................... Department has been enrolled under the West Bengal Health Scheme, 2008, with effect from ........................... The particulars of the members of his family as defined in para 3(e) of the Scheme are as follows : Name of Government employee Designation Residential address Date of birth Date of entry into Government service Date of superannuation Present pay (Basic + Dearness Pay) Details of Family Sl. No. Name Age Relationship Monthly income, if any 1. 2. 3. 4. 5. Signature of the Cadre Controlling Authority/Head of the Office Copy forwarded for information and necessary action to : 1. 2. Shri/Smt ..........................................................................................(designation) The ...................................................................................(Drawing and Disbursing Officer). He is requested to discontinue the drawal of regular medical allowance in respect of Shri/Smt ................................................................with effect from ................................................................ : : : : : : : 10 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I FORM C Application Form for settlement of claim for reimbursement. (See sub-clause (1) of clause 12) (To be filled in by the applicant) 1. 2. Identity Card (meant for the Scheme) No. Full name of the Govt. Employee with designation (in Block letters) 3. Full Address : (i) (ii) 4. Office Residence : : : : Name of the patient & relationship with the Govt. Employee : : : 5. 6. Pay (Basic + Dearness Pay) Name of the Hospital with address (a) OPD treatment & investigation (b) Indoor treatment & investigation 7. Date of admission : ________________________ Date of discharge : ___________________________ (in case of indoor treatment only) 8. Total amount claimed – (a) OPD treatment (b) Indoor treatment : : : : 9. Details of permission 10. Details of Medical advance, if any DECLARATION I hereby declare that the statements made in the application are true to the best of my knowledge and belief and the person for whom medical expenses were incurred is wholly dependent on me. I am a beneficiary of the West Bengal Health Scheme, 2008, and the card issued under the Scheme was valid at the time of treatment. I agree for the reimbursement as is admissible under the rules. Date : Signature of the Govt. Employee PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 11 FORM D Essentiality Certificate-cum-Statement of Expenditure Certified by Treating Specialist (See sub-clause (3) of clause 12) (to be submitted in duplicate) (Strike out whichever is not applicable) 1. Name of the patient and relationship with Govt. Employee 2. Details of expenditure (A) OPD Treatment (I) Name of the Hospital : : : : Diagnosis : (II) Total No. of vouchers (III) Amount claimed (Indicate serial number of individual vouchers with name and address of the shops with date against each subheading in a separate annexure wherever required) Amount Claimed Amount admissible (for official use) (a) Medicine ........................................ ........................................ .......................................... ......................................... (b) Consultation fees (Specify number of consultations) (c) Laboratory charges (Break-up in a separate annexure) (d) Disposable surgical Sundries (e) Special devices like hearing aid/artificial appliances etc. (specify) (f) Miscellaneous (specify) Total : ........................................ ......................................... .......................................... .......................................... .......................................... .......................................... ......................................... .......................................... 12 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (B) Indoor Treatment (To be marked N.A. wherever necessary) Diagnosis (Details of Hospital Bill and other vouchers pertaining to the period of indoor treatment) (a) Name of the Hospital with address (b) Period of Bill (c) Amount claimed (indicate serial number of individual vouchers with name and address of shops with date against each subheading in a separate annexure wherever required) Amount Claimed (i) Room Rent (ICU/ICCU/Ward) From __________ To _____________ (ii) Charges for : (a) (b) (c) (d) O.T. O.T. Consumables Anesthesia Procedure ........................................ ....................................... ....................................... ....................................... ....................................... ....................................... .................................. .................................. .................................. ................................. ................................. ................................. : ........................................ .................................. Amount admissible (for official use) : From ______________ To _________________ : (iii) Medicines (iv) Implants like pacemaker, Joint Replacement, coronary stent etc. (details) (v) Artificial devices (details) (vi) Lab Charges (Break-Up given in Annexure) (vii) Spl. Nurse/Ayah, if any (viii) Miscellaneous Total : ....................................... ....................................... ....................................... ....................................... ....................................... ................................. ................................. ................................. ................................. ................................. (Signature of Claimant) Name in Block Letters Address : PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 13 1. Certified that the relevant bills/vouchers have been verified by me and the expenditure shown above is correct and the treatment services provided are essential and minimum that required for the recovery of the patient 2. Certified that the services of Special Nurse/Ayah were required from ________________ to ______________ that were absolutely essential for the recovery of the patient. 3. Specific procedure/Operation performed was ___________________________________________________ (Signature of the Treating Specialist with official seal) Countersigned by Medical Superintendent of the Hospital with seal (For Indoor treatment only) FORM E Checklist For Reimbursement of Medical Claims (See sub-clause (3) of clause 12) 1. 2. 3. Card No. and place of issue Entitlement Full name of Card Holder Govt. employee (block letters) Designation The following documents are submitted (please tick [ü] the relevant column) (a) Photocopy of the identity : : : Private/Semi-Private/General ward 4. 5. : : : : : : Yes/No. Yes/No. (b) Essentiality Certificate (c) Number of original bills (d) Whether original bills/vouchers have been verified (e) (f) Copy of discharge summary Copy of permission letter Yes/No. : : : Yes/No. Yes/No. Yes/No. (g) Whether the hospital has given break up for lab investigations 14 THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 [PART I (h) Original papers have been lost the following documents are submitted (I) Photocopies of claim paper : : Yes/No. Yes/No. (II) Affidavit on stamp paper (i) In case of death of card-holder the following documents are submitted Affidavit on stamp paper by claimant (I) : Yes/No. (II) No objection from other legal heirs on stamp papers (III) Copy of death certificate : Yes/No. : Yes/No. Dated............................... Signature of the Applicant Form - F Temporary Family Permit [See sub-clause (9) of clause 10] 1. 2. 3. 4. 5. 6. 7. 8. 9. Name of the Govt. employee Employee code No. (GPF No.) Designation Present Pay (Basic pay+Dearness Pay) Entitlement of accommodation Date of birth Date of Superannuation Residential address Details of Family : : : : : : : : : PART I] THE KOLKATA GAZETTE, EXTRAORDINARY, SEPTEMBER 19, 2008 15 SI. No. Name Age Relationship Monthly Income, if any. 1. 2. 3. 4. 5. Shri/Smt. ............................................................... attached to .............................................................(office) under ................................................. Department has been enrolled under the West Bengal Health Scheme, 2008 with effect from ........................................... He/She and his/her family members are entitled to the medical attendance and treatment in a Govt. Hospital/ enlisted Pvt. Hospital or Institution etc. in the entitled class mentioned in SI. No.5 This permit is valid for 6 (six) months from the date of issue. Signature of Cadre controlling authority/Head of the office. By order of the Governor, D. MUKHOPADHYAY, Principal Secy. to the Govt. of West Bengal. 16 Registered No. WB/SC-247 No. WB(Part-I)/2008/SAR-155 The Kolkata Extraordinary Published by Authority JYAISTHA 4] MONDAY, MAY 25, 2009 [SAKA 1931 Gazette PART I—Orders and Notifications by the Governor of West Bengal, the High Court, Government Treasury, etc. Government of West Bengal Finance Department Audit Branch NOTIFICATION No: 3472-F dt. : 11.05.09. In exercise of the power conferred by Sub-clause (2) of Clause- 1 of the West Bengal Health Scheme, 2008, the Governor is hereby pleased to appoint the 1st June, 2009 as the date on which the said Scheme shall come into force. By order of the Governor, D. Mukhopadhyay, Principal Secretary to the Govt. of West Bengal. 17 Government of West Bengal Finance Department Audit Branch NOTIFICATION No: 3473 F dt. : 11.05.09. The Governor is pleased to recognize the following Hospitals/ Institutions, Laboratories/ Diagnostic Centres for the purpose of availing benefits of medical attendance and treatment under the West Bengal Health Scheme, 2008. (i) All Hospitals (all systems of medicines), clinics, laboratories and diagnostic centres under the management of the Govt. of West Bengal. (Code: 0110000) (ii) All hospitals, clinics, diagnostic centres managed by the Municipal Corporations/ Municipalities and the other Local Bodies within the State of West Bengal. (Code: 0210000) (iii) State aided Hospitals (Code: 03), as follows:(a) Ramkrishna Mission Seva Pratisthan, Sarat Bose Road, Kolkata. (Code: 0310001) (b) Islamia Hospital, Kolkata, (Code: 0310002) (c) Marwari Relief Society Hospital, Kolkata, (Code: 0310003) (d) Institute of Child Care, Kolkata, (Code: 0310004) (e) Balananda Brahmachari Hospital, Behala, Kolkata, (Code: 0310005) (f) Chittaranjan Cancer Hospital, Kolkata, (Code: 0310006) (g) Ramkrishna Sarada Mission Matri Bhavan, 7A, Sree Mohan Lane, Kolkata- 28. (Code: 0310007) (h) Dr. M. N. Chatterjee Memorial Eye Hospital, Kolkata, (Code: 0310008) (i) (j) (l) Ramkrishna Matri Mangal Pratisthan and B.C.Roy Sishu Sadan, Ariahdah, North 24 Parganas, (Code: 0310009) J. N. Roy Sishu Seva Bhavan, Kolkata, (Code: 0310010) Kalimpong Leprosy Hospital, Kalimpong, Darjeeling, (Code: 0310012) (k) Chartoris Hospital, Kalimpong, Darjeeling, (Code: 0310011) (m) Sri Balaram Seva Mandir, Khardah, North 24 Parganas. (Code: 0310013) (iv) Empanelled Private Hospitals, Nursing Homes, Institutions, Clinics, Laboratories, Diagnostic Centres within the State (Code: 04) as per list attached in Annexure- A. Such Private Hospitals, Nursing Homes, etc has been classified into Class- 1, Class- 2 and Class- 3 Service Provider on the basis of facilities available there. Each empanelled Hospital/ Diagnostic Centre has come into agreement with the Govt. of West Bengal on the basis of Memorandum of Agreement and the agreement shall remain in force for a period of 2 (two) years or till it is modified or revoked whichever is earlier. 18 (v) Speciality Hospitals outside the State (Code: 05) :— (a) All India Institute of Medical Sciences, New Delhi, (Code: 0510001) (b) Post Graduate Institute of Medical Education and Research, Chandigarh, (Code: 0510002) (c) Tata Memorial Hospital, Mumbai, (Code: 0510003) (d) N I M H A N S, Bangalore, (Code: 0510004) (e) Christian Medical College, Vellore, Tamil Nadu, (Code: 0510005) (f) Apollo Hospitals, Chennai, Tamil Nadu, (Code: 0510006) (g) Sankara Netralaya, Chennai, Tamil Nadu. (Code: 0510007) (h) L.V.Prasad Eye Hospital, Hyderabad, Andhrapradesh, (Code: 0510008) 2. The Governor is further pleased to approve the rates for Specialised Medical Treatment/ Services, Procedures and Investigations required in connection with the medical attendance and treatment of a beneficiary within the State as per list at Annexure- B attached. The rates shall be valid for two years. Note: (a) Class- 1 Service Providers (Code: 1) shall charge 100% of the approved rate or actual rate of the Service Provider whichever is less. (b) Class- 2 Service Providers (Code: 2) shall charge 80% of the approved rate or actual rate of the Service Provider whichever is less. (c) Class- 3 Service Providers (Code: 3) shall charge 70% of the approved rate or actual rate of the Service Provider whichever is less. 3. The Governor is also pleased to make the following amendment to the West Bengal Health Scheme, 2008 — for table under Clause- 8 substitute the following table:— Sl. No. (1) 1. 2. 3. Category of Employee (2) I II III Basic Pay (Band Pay including Grade Pay) (3) Above Rs. 27,000 p.m. Rs. 18,000 p.m. and above but below Rs. 27,000 p.m. Below Rs. 18,000 p.m. Type of accommodation ( 4) Private Ward Semi-Private Ward General Ward By order of the Governor D. Mukhopadhyay, Principal Secretary to the Government of West Bengal 19 Annexure- A (Notification No. 3473-F dt 11.05.09.) PRIVATE HOSPITALS/ SPECIALITY HOSPITALS (Class Code : 1) Class-1 Service Provider Sl. No. Name of Health Care Organization (H.C.O.) P N Memorial Neuro Centre & Research Centre Ltd. 0411002 0411003 0411004 The Calcutta Medical Research Institute Nightingale Hospital Apollo Gleneagles Hospital Address of H.C.O. Class Recommended 0411001 Desun More, Kasba, Kolkata-107. Tel No. (033) 2443-4567 7/ 2 DH Rd, Kolkata Tel No. 033-2456-7700 11 Shakespeare Sarani, Kolkata Tel No. 033-2282-7263 58, Canal Circular Rd., Kolkata-700054. Tel No. 033-2320-3040 Class- 1 Multi Speciality Hospital Class- 1 Multi Speciality Hospital Class- 1 Multi Speciality Hospital Class- 1 Multi Speciality Hospital Class- 1 Multi Speciality Hospital Class- 1 Multi Speciality Hospital Class- 1 Cardiac Care UniSpeciality Hospital Class- 1 Multi Speciality Hospital Class- 1 ENT Uni Speciality Centre Class- 1 Multi Speciality Hospital with Diagnostic facility Class-1, Multi Speciality Hospital with Diagnostic facility 0411005 Advanced Medicare & Research Institute Malda Nursing home B.M. Birla Heart Research Centre R N Tagore International Inst. Of cardiac Sciences P- 4 & 5 CIT Scheme LXXII, Block- A, Gariahat Rd., Kol- 29. Tel No. 033-2440-4803 B.G.Road, Makdumpur, Malda Tel No. 9434039705 1/ 1 National Library Avenue, Kolkata-27. Tel No. (033) 2456-7890 124 Mukundapur EM Bypass, Kolkata- 99. Tel No. 033-2436-1268 P-13, Nirala Co-operative , Mukundapur, Kolkata - 700099 Tel No. 033-2426-4901 0411006 0411007 0411008 0411009 Medica ENT Institute 0411010 Medica North Bengal Clinic Meghnad Saha Sarani, Pradhan Nagar, Siliguri – 734003 Tele No. 03532518667 0411011 Ruby General Hospital Kasba Gol Park, EM Byepass Kolkata-700 107 Tele No. (033) 2442-6091 20 Annexure- A (Notification No. 3473-F dt 11.05.09.) Class-2 Service Provider (Class Code: 2) Sl. No. 0412201 Name of Health Care Organization (H.C.O.) Silverline Eye Hospital Address of H.C.O. 396 Prince Anwar Shah Rd, Kolkata-45. Tel No. 9830147894 Biplabi Niketan, 12A Biresh Guha Street, Kolkata-700017 Tel No. 033-2280-2809 Samarendranath Colony, P.O.-Nabapally, Barasat, North 24 Parganas, Pin 700126. Tel No. 033-2542-6732 Budbud Bypass North, Budbud, Burdwan Tel No. 0343-6454-761 Patpur, Jail Road, Bankura-722101. Tel No. 9332915566 Class Recommended Class- 2 Eye Care Centre 0412202 Eye Care & Research Centre Class- 2 Eye Care Centre (Day Care) Class 2 Multi Speciality Hospital 0412203 Care & Cure Hospital 0412204 Kalyan General Hospital Class-2 Multi Speciality Hospital with Diagnostic Centre Class - 2, Multi Speciality Hospital 0412205 Bankura Seva Niketan Class-3 Service Provider (Class Code: 3) Sl. No. 0413401 Name of Health Care Organization (H.C.O.) Sunrise Nursing Home (P) Ltd. Address of H.C.O. Udham Singh Sarani, Ashrampara, Sevoke Road, Siliguri, Darjeeling Tele No. 0353-2643692 Class Recommended Class 3 Multi Speciality Hospital 21 Annexure- A (Notification No. 3473-F dt 11.05.09.) DIAGNOSTIC CENTRES Class-1 Service Provider Sl. No. 0421001 0421002 Name of Health Care Organization (H.C.O) Ashok Laboratory Neon Health Care & Research Institute Ltd. Sono Scan Diagnostic Centre Pulse Diagnostic Pvt. Ltd. Address of H.C.O. 390 B Jodhpur Park, Kolkata-68. Tel No. 033-2472-4068 S 16 Kasba Industrial Estate, Kol- 107 Tel No. 9903197808 BG Road, Makdumpur, Malda Tel No. 9434039705 75, Sarat Bose Road, Kolkata-29. Tel No. 033-2454-6142 Class Recommended Class-1 Diagnostic Class-1 Diagnostic 0421003 0421004 Class-1 Diagnostic Class-1 Diagnostic Class-2 Service Provider Sl. No. 0422201 0422202 0422203 0422204 0422205 0422206 Name of Health Care Organization (H.C.O) Mediclue Research & Diagnostic Pvt. Ltd. Suraksha Diagnostic & Eye Care Pvt. Ltd. Suraksha Diagnostic Pvt. Ltd. Suraksha Diagnostic Pvt. Ltd. Suraksha Diagnostic & Eye Centre Pvt. Ltd. Eastern Diagnostic Centre Ltd. Address of H.C.O. 68 Chowringhee Rd, Kolkata-20. Tel No. 033-2241-5907 P 118 CIT Rd, Kolkata- 54. Tel No. 033-2941-8566 Keshtopur Clinic, Kolkata- 101. Tel No. 033-2941-8566 Rajbaripara, Jalpaiguri-735101 15/ 10 Udham Singh Sarani, Siliguri 13C, Mirza Galib Street, Kolkata- 700016 Tel No. 033-2217-8080 Class Recommended Class-2 Diagnostic Class-2 Diagnostic Class-2 Diagnostic Class-2 Diagnostic Class-2 Diagnostic Class-2 Diagnostic Class-3 Service Provider Sl. No. 0423401 Name of Health Care Organization (H.C.O) Narcissus Medical Centre Address of H.C.O. 12, Dr. G. C. Goswami Street, Serampur, Hooghly-712201 Tel No. (033)-2652-2286 Class Recommended Class-3, Diagonistic 22 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Given below is the list of maximum allowable rates to be charged from the beneficiaries of the West Bengal Health Scheme 2008. (b) Cost of devices/ implants like Pace maker, Stents, Heart Valves, etc. B) The rate quoted for a particular procedure is inclusive of all sub-procedures and all related procedures to complete the treatment. As an illustration, it may be noted that for 'Knee replacement' the quoted rate is inclusive of cost of implants, disposables like bandages, anaesthetic drugs, syringes, etc. Similarly, for TRUP, the procedures such as Urethral Catheterization, Cystoscopy, etc. should not be billed separately as they are all part of the Procedure i.e. TRUP. C) The package rates of Indoor Treatment are of following duration of hospitalization i. 12 days for specialized procedure, ii. 7 - 8 days for other procedure, iii. 3 days for Laparoscopic Surgery, iv. 1 day for day care / minor procedures (OPD), No additional charge on account of extended period of any stay shall be allowed if extension is due to improper procedure or infection as the consequences of surgical procedure done and not justified. Recognised Private hospital/diagnostic centres have entered into an agreement with the WBHS Authority for providing services at their notified rates or scheduled rates approved by the Government, whichever is less. The beneficiaries will be charged from the scheduled rates according to the Class of Service provider as given below: 1. Class 1 Service Provider- Full rates 2. Class 2 Service Provider- 80% of full rates 3. Class 3 Service Provider- 70% of full rates APPROVED PACKAGE RATES A) Package rate is defined as lump sum cost of inpatient treatment/day care. This includes all charges pertaining to a particular treatment / procedure including: i. Registration charges, ii. Admission charges. iii. Accommodation charges including diet for the patient, iv. Operation charges v. Injection charges, vi. Dressing charges, vii. All Doctor/consultant visit charges, viii. ICU/ICCU charges, ix. Monitoring charges, x. Transfusion charges, xi. Anaesthesia charges, xii. Operation theatre charges, xiii. Procedural charges/surgeon's fee, xiv. Cost of all surgical disposables and all sundries used during hospitalization, xv. Cost of all medicines. xvi. All related routine and essential investigations, xvii. Nursing Care and charges for its services, xviii. Physiotherapy charges etc. from the time of admission to time of discharge. The above list is an illustrative one only. The package rate, however, does not include expenses on: (a) i. telephone, ii. tonics, iii. cosmetics & toiletries. 23 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum RATES LIST OF PROCEDURES : CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) 01 – PROCEDURES (Rs.) CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) 001 -GENERAL First Consultation by Medical Officer / Resident Doctor Subsequent Consultation by Medical Officer / Resident Doctor First Visit by Specialists Revisit by Specialists or each subsequent visit Injections - SC Injection - IM Injection - IV Single Drug Therapy per day Multiple Drug Therapy per day Infusional Chemotherapy Dressings Large Suturing without local anesthesia Suturing of wounds with local anesthesia Removal of Foreign body Removal of Benign Tumor Aspiration Plural Effusion Therapeutic Abdominal Aspiration Therapeutic Pericardial Aspiration Bone Marrow Aspiration Joints Aspiration Strapping Removal of Stitches Venesection Phimosis Under LA 01001025 01001026 01001027 01001028 01001029 01001030 01001031 01001032 01001033 01002001 01002002 01002003 01002004 01002005 01002006 01002007 Lumbar puncture Sternal puncture Injection for Haemorrhoids Injection for Varicose Veins Catheterisation Dilatation of Urethra Incision & Drainage Intercostal Drainage Peritoneal dialysis 002 - Skin Excision of Moles Excision of Warts Excision of Molluscum contagiosum Excision of Veneral Warts Excision of Corns I/D Injection Keloid of Acne Chemical Cautery (per sitting) 003 - E.N.T. Speech therapy per session of 30-40 minutes Removal of foreign body From Nose Removal of foreign body From Ear Syringing Polyp removal under LA Peritonsillar abscess drainage under LA Ear Piercing Myringoplasty Staepedectomy Myringotomy Grommet Insertion Tympanotomy Paracentesis Tympanoplasty Rs.660/Rs.600/Rs.960/Rs.1278/Rs.116/Rs.1020/Rs.582/Rs.966/Rs.1818/Rs 570/Rs.570/Rs 570/Rs.600/Rs.540/Rs.300/Rs.120/- 01001001 01001002 01001003 01001004 01001005 01001006 01001007 01001008 01001009 01001010 01001011 01001012 01001013 01001014 01001015 01001016 01001017 01001018 01001019 01001020 01001021 01001022 01001023 01001024 Rs.150/Rs.150/Rs.150/Rs.150/Rs.18/Rs.24/Rs.24/Rs.576/Rs.768/Rs.864/Rs.144/Rs.372/Rs.498/Rs.1091/Rs.1091/Rs.960/Rs.1260/Rs.364/Rs.630/Rs.558/Rs 96/Rs.60/Rs.264/Rs.1446/- 01003001 01003002 01003003 01003004 01003005 01003006 01003007 01003008 01003009 01003010 01003011 01003012 01003013 01003014 Rs.180/Rs.240/Rs.240/Rs.300/Rs.774/Rs.1548/Rs.570/Rs.10680/Rs.12000/Rs.4800/Rs.5076/Rs.5400/Rs.4314/Rs.10080/- 24 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Mastoidectomy Otoplasty Labyrinthectomy Skull Base surgery Facial Nerve Decompression Septoplasty Submucous Resection Septo-rhinoplasty Rhinoplasty Fracture Reduction Intra Nasal Diathermy Turbinectomy Endoscopic DCR Endoscopic Surgery Septal Perf. Repair Antrum Puncture Lateral Rhinotomy Cranio-facial resection Ethamoidectomy Caldwell Luc Surgery Angiofibroma Excision Endoscopic Hypophysectomy Endoscopic Optic Nerve Decompression Decompression of Optic Nerve Ranula Excision Tongue Tie excision Sub Mandibular Duct Lithotomy Adenoidectomy Palatopharyngoplasty Cleft Palate repair Pharyngoplasty Styloidectomy 004 - Eye Cauterisation of ulcer/subconjuctival injection - One eye Rs.15600/Rs.15600/Rs.15600/Rs.37936/Rs.17232/Rs.10200/Rs.10800/Rs.11530/Rs.12000/Rs.9000/Rs. 6000/Rs. 9600/Rs. 7500/Rs.11472/Rs.11400/Rs.4938/Rs.1320/Rs.19200/Rs.17616/Rs.11472/Rs.13200/Rs.15600/Rs.15300/Rs.12000/Rs.9600/Rs.8100/Rs.9696/Rs.10536/Rs.15048/Rs.15600/Rs.15600/Rs.11472/- CODE 01004002 01004003 01004004 01004005 01004006 01004007 01004008 01004009 01004010 01004011 01004012 01004013 01004014 01004015 01004016 01004017 01004018 01004019 01004020 01004021 01004022 01004023 01004024 01004025 01004026 01004027 01004028 01004029 01004030 Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Cauterisation of ulcer/subconjuctival injection - Both eyes Retrobular Injection One Eye Retrobular Injection Both Eyes Syringing of Lacrimal Sac For one eye Syringing of Lacrimal Sac For both eyes Paracentesis Foreign body removal Refraction/Fundoscopy Ortho-optic exercises Plepoptic Exercises Chalazion operation -One Eye Chalazion operation Both Eyes Dressing (Eye) Clinical Photography Pterygium Orbitotomy Ptosis correction Ectropion Correction Xenon Arc Laser D C R (Dacryo custorhinostomy) ECCE/ICCE Epicanthus correction. Squint Correction Keratoplasty Trabeculotomy Trabeculectomy Iridectomy Goniotomy Scalaral Bukling (Retinal Detachment Surgery) Rs.290/Rs.192/Rs.288/Rs.180/Rs.264/Rs.780/Rs.300/Rs.84/Rs.96/Rs.96/Rs.780/Rs.970/Rs.90/Rs.90/Rs.2154/Rs.3485/Rs.6480/Rs.3600/Rs.702/Rs.5700/Rs.5064/Rs.2040/Rs.5850/Rs.13800/Rs.5700/Rs.5700/Rs.2340/Rs.2400/Rs.11274/- 01003015 01003016 01003017 01003018 01003019 01003020 01003021 01003022 01003023 01003024 01003025 01003026 01003027 01003028 01003029 01003030 01003031 01003032 01003033 01003034 01003035 01003036 01003037 01003038 01003039 01003040 01003041 01003042 01003043 01003044 01003045 01003046 01004001 Rs.194/- 25 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Syringing & Probing Vitrectomy Enucleation Eviseration Entropion correction Cataract with IOL (Cost of lens extra) 005 - Orthopaedic & Plaster Work Fingers (post, slab) Fingers full plaster Colles Fracture - Below elbow Colles Fracture - Full plaster Colles fracture Ant. Or post. slab Above elbow full plaster Above Knee post-slab Below Knee full plaster Below Knee post-slab Tube Plaster (or plaster cylinder) Above knee full plaster Above knee full slab Minerva Jacket Plaster Jacket Shoulder spica Single Hip spica Double Hip spica 006 - Strapping. Strapping of Finger Strapping of Toes Strapping of Wrist Strapping of Elbow Strapping of Knee Strapping of Ankle Strapping of Chest Strapping of Shoulder Rs.1056/Rs.10560/Rs.3900/Rs.3720/Rs.2940/Rs.7500/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Nasal bone fracture Figure of 8 bandage Colar and cuff sling Ball bandage 007 - Physiotheraphy Ultrasonic therapy (per sitting) S.W. Diathermy (per sitting) Electrical stimulation (therapeutic) (per sitting) Infra red (per sitting) U.V. Therapeutic dose (per sitting) Electric vibrator (per sitting) Vibrator belt massage (per sitting) Intra Lumbar Traction (per sitting) Intermittent Cervical traction (per sitting) Combined Lumbar & Cervical traction (per sitting) Wax bath (per sitting) Hot pack (per sitting) Whirl pool bath (per sitting) Obesity Exercises (per sitting) Breathing Exercises & Postural Drainage (per sitting) Cerebral Palsy - Massage (per sitting) Post - polio exercise (per sitting) 008 - Dental Extraction of tooth including LA Rs.420/Rs.450/Rs.420/Rs.420/- 01004031 01004032 01004033 01004034 01004035 01004036 01006009 01006010 01006011 01006012 01007001 01007002 Rs.66/Rs.84/Rs.72/Rs.84/Rs.84/Rs. 84/Rs.84/Rs.84/Rs.72/Rs.72/Rs.48/Rs.66/Rs.84/Rs.58/Rs.64/Rs.84/Rs.60/- 01005001 01005002 01005003 01005004 01005005 01005006 01005007 01005008 01005009 01005010 01005011 01005012 01005013 01005014 01005015 01005016 01005017 01006001 01006002 01006003 01006004 01006005 01006006 01006007 01006008 Rs.288/Rs.288/Rs.1200/Rs.1968/Rs.1020/Rs.960/Rs.678/Rs.990/Rs.750/Rs.1440/Rs.2400/Rs.2220/Rs.4020/Rs.3048/Rs.3348/Rs.3090/Rs.3792/Rs.192/Rs.192/Rs.360/Rs.384/Rs.384/Rs.372/Rs.480/Rs.450/- 01007003 01007004 01007005 01007006 01007007 01007008 01007009 01007010 01007011 01007012 01007013 01007014 01007015 01007016 01007017 01008001 Rs.121/- 26 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01008002 01008003 01008004 01008005 01008006 01008007 01008008 01008009 Complicated Ext. per Tooth including LA Rs.240/Flap Operation per Tooth Rs.480/Gingivectomy per tooth Rs.288/Cyst under LA (small) Rs.288/Cyst under LA (large) Rs.485/Impacted Molar including LA Rs.768/Apisectomy including LA Rs.970/Fracture wiring including LA Rs.78/009 - ICU/CCU CHARGES (Special Care Cases) Coronary Care with Cardiac Monitoring including ECG & Diet Rs.1752/Respirator & Compressed air Rs.1560/Respirator with Piped Oxygen Rs.1560/Post operative care (ICU) with Diet Rs.1656/Child care in children Rs.690/Paediatric care for New born, per day (7 to 12 days) Rs.540/General Nursery Care Rs.360/Incubator charges (Per day) Rs.600/Intensive care in Nursery (Per day) Rs.1200/Phototherapy Rs.364/Resuscitation Rs.364/Resuscitation with Incubator attended by Specialist Rs.900/Exchange Transfusion Rs.1140/O.T. Charges for Exchange transfusion Rs.364/Pneupack ventilator in Nursery (Per day) Rs.846/010 - Oxygen Charges Operation theatre (including supply of Nitrous Oxide) Rs.900/Casuality ICU Rs.96/01010003 01010004 01011001 01011002 01011003 01011004 01011005 01011006 General Ward Semi-private wards 011 - Burn Dressing upto 30% Burns 1st Dressing upto 30% Burns Subsequent Dressing 30% to 50% Burns 1st Dressing 30% to 50% Burns Subsequent Dressing Extensive Burn above 50% First Dressing Extensive Burn above 50% Subsequent dressing 012 - Obstetric & Gynaecology Cases Normal delivery or with Episiotomy & P. repair Low Forceps Low midcavity forceps Cesarean Section Cesarean Hysterectomy Rupture Uterus- closure & repair with Tubal Ligation Perforation of Uterus after D/E Laparotomy & Closure Laparotomy-peritonitis Lavage and Drainage Laparotomy-failed laparoscopy to explore Salphingectomy Salphingo-Oophorectomy Ovarean Cystectomy Oopherctomy Broad Ligment Haemotoma Drainage Exploration of perineal Haematoma & Resuturing of Episiotomy Rs.97/Rs.96/- Rs.364/Rs.240/Rs.606/Rs.302/Rs.970/Rs.364/- 01009001 01009002 01009003 01009004 01009005 01009006 01009007 01009008 01009009 01009010 01009011 01009012 01009013 01009014 01009015 01012001 01012002 01012003 01012004 01012005 01012006 01012007 01012008 01012009 01012010 01012011 01012012 01012013 01012014 01012015 Rs.8400/Rs.9000/Rs.9600/Rs.14370/Rs.19200/Rs.18000/Rs.14400/Rs.12120/Rs.6060/Rs.11634/Rs.15078/Rs.14400/Rs.12120/Rs.10128/Rs.9648/- 01010001 01010002 27 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Exploration of abdominal Haematoma (after laparotomy + LUCS) Internal podalic version and extraction Manual Removal of Placenta 3rd stage Complication MRP for outside delivery etc Examination under anaesthesia Burst-abdomen Repair Gaping Pareneal Wound Secondary Suturing Gaping abdominal wound Secondary Suturing Complete perineal tear-repair Exploration of PPH-tear repair Destructive Operation Suction evacuation vesicular mole, Missed abortion D/E Colpotomy-drainage P/V needling EUA Repair of post-coital tear, perineal injury Excision of urethral caruncle Laparoscopy (Gynae) Shirodhkar, Mc. Donalds stich 013 - General Surgery Drainage of Abscess Dressing under G.A. Aspiration of cold Abscess of Lymphnode Aspiration of Empyema Aspiration of Liver Abscess Open Drainage of Liver Abscess Drainage of Pelvic Abscess Drainage of Ischiorectal Abscess Rs.12000/Rs.9648/Rs.3636/Rs.4848/Rs.2424/Rs.3222/Rs.2424/Rs.3636/Rs.2424/Rs.4121/Rs.10854/Rs.5818/Rs.4121/Rs.4121/Rs.3636/Rs.6060/Rs.3636/Rs.1680/Rs.2400/Rs.3060/Rs.2412/Rs.2424/Rs.9048/Rs.9600/Rs.6600/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Drainage of Subdiaphragmatic Abscess Rs.11460/Open Drainage of Perinepheric Abscess Rs.11460/Drainage of Perigastric Abscess Rs.9600/Drainage of Perotid Abscess Rs.6300/Drainage of Retropharyngeal Abscess Rs.6300/Open Drainage of Psoas Abscess Rs.6300/Open Drainage of Perivertebral Abscess Rs. 8790/014 - Injury Of Superficial Soft Tissues Suturing of small wounds Rs.290/Secondary suture of wounds Rs.1206/Delayed primary suture Rs.1692/Debridement of wounds Rs.1212/015 - Removal Of Foreign Bodies Removal of F.B. Superficial Rs.1212/Removal of F.B. Deep Rs.2412/016 - Excision Of Cyst / Small Tumours Excision of Sebaceous Cysts Rs.1680/Excision of Superficial Liipoma Rs.2412/Excision of Superficial Neurofibroma Rs.2760/Excision of Dermoid Cysts Rs.2424/Haemorrhoids Rs.8442/Keloids Rs.5310/Superficial Varicosity Rs.4848/017 - Head & Neck Ear Lobe Repair one side Rs.606/Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin Only Rs.3618/- 01012016 01012017 01012018 01012019 01012020 01012021 01012022 01012023 01012024 01012025 01012026 01012027 01012028 01012029 01012030 01012031 01012032 01013001 01013002 01013003 01013004 01013005 01013006 01013007 01013008 01013009 01013010 01013011 01013012 01013013 01013014 01013015 01014001 01014002 01014003 01014004 01015001 01015002 01016001 01016002 01016003 01016004 01016005 01016006 01016007 01017001 01017002 28 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Excision of Pinna for Growth (Squamous/Basal/ Injuries) Skin and Cartilage Partial Amputation of Pinna Total Amputation of Pinna Total Amputation & Excision of External Auditory Meatus Excision of Cystic Hygroma Minor Excision of Cystic Hygroma Major Excision of Cystic Hygroma Extensive Excision of Branchial Cyst Excision of Branchial Sinus Excision of Pharyngeal Diverticulum Excision of Carotid BodyTumours Operation for Cervical Rib Block Dissection of Cervical Lymph Nodes Pharyngectomy & Reconstruction Operation for Carcinoma Lip - Wedge Excision Block Dissection of Cervical Lymph Nodes Pharyngectomy & Reconstruction Operation for Carcinoma Lip - Wedge Excision Operation for Carcinoma Lip - Vermilionectomy Operation for Carcinoma Lip - Wedge Excision and Vermilonectomy Estlander Operation Abbe Operation Cheek Advancement Excision of the Maxilla Excision of the Mandible Segmental Rs.5310/Rs.5818/Rs.7030/Rs.10254/Rs.5333/Rs.7999/Rs.12270/Rs.10800/Rs.9648/Rs.12120/Rs.28800/Rs.17400/Rs.19440/Rs.24000/Rs.7200/Rs.20220/Rs.31200/Rs.7757/Rs.7272/Rs.8484/Rs.9696/Rs.9600/Rs.10200/Rs.23220/Rs.18090/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Hemimandibulectomy Partial Glossectomy Hemiglossectomy Total Glossectomy Commando Operation Parotidectomy - Superficial Parotidectomy Conservative Parotidectomy - Radical Total Repair of Parotid Duct Removal of Submandibular Salivary gland Hemithyroidectomy Partial Thyroidectomy Subtotal Thyroidectomy (Toxic Goitre) Total Thyroidectomy (Cancer) Resection Enucleation of Adenoma Isthmectomy Total Thyroidectomy and Block Dissection Excision of Lingual Thyroid Excision of Thyroglossal Cyst/Fistula Excision of Parathyroid Adenoma/Carcinoma Laryngectomy Laryngo Pharyngectomy Sinus & Fistula repair Lymph Node Excision Hyoid Suspension Genioplasty Direct Laryngoscopy Phonosurgery Fibroptic Laryngoscopy Microlaryngeal Surgery Rs.27132/Rs.6060/Rs.13380/Rs.24960/Rs.27000/Rs.24000/Rs.19680/Rs.12605/Rs.20400/Rs.9938/Rs.14544/Rs.13574/Rs.20628/Rs.22800/Rs.12510/Rs.12605/Rs.31350/Rs.25620/Rs.12120/Rs.25590/Rs.37152/Rs.43440/Rs.11100/Rs.7266/Rs.12000/Rs.11436/Rs.5400/Rs.15360/Rs.3000/Rs.10562/- 01017003 01017004 01017005 01017006 01017007 01017008 01017009 01017010 01017011 01017012 01017013 01017014 01017015 01017016 01017017 01017018 01017019 01017020 01017021 01017022 01017023 01017024 01017025 01017026 01017027 01017028 01017029 01017030 01017031 01017032 01017033 01017034 01017035 01017036 01017037 01017038 01017039 01017040 01017041 01017042 01017043 01017044 01017045 01017046 01017047 01017048 01017049 01017050 01017051 01017052 01017053 01017054 01017055 01017056 01017057 29 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE 01017058 01017059 01018001 01018002 01018003 01018004 01018005 01018006 01018007 01019001 01019002 01019003 01019004 01019005 01019006 01020001 01020002 01020003 01020004 01020005 01020006 01020007 01020008 01020009 01020010 01020011 01020012 01020013 Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Laryngofissure Stenosis Excision 018 - Head & Neck Cancer Benign Tumour Excisions Temporal Bone resection Radical Neck Dissection Carotid Body Excision Total Laryngectomy Flap Reconstructive Surgery Parapharyngeal Tumour Excision 019 - Breast Drainage of Abscess Excision of Lumps Local Mastectomy (Simple) Radical Mastectomy (Formal or Modified) Excision of Mammary Fistula Segment Resection of Breast 020 - Cardio Respiratory Procedures Tracheostomy Thoracotomy (Penetrating Wounds) Intercostal Drainage of empyema Decortication (Pleurectomy) Thoracoplasty Pneumonectomy Lobectomy Segmental Resection Hydatid Cyst Video-assisted thoracoscopic lung Surgeries Lung volume reduction surgery Thoracoscopic Decortication Thoracoscopic Pneumonectomy Rs.11736/Rs.16116/Rs.8100/Rs.27533/Rs.28416/Rs.36000/Rs.34150/Rs.42720/Rs.19800/Rs.5700/Rs.9300/Rs.13470/Rs.24000/Rs.13530/Rs.18300/Rs.3636/Rs.17453/Rs.5400/Rs.25500/Rs.36360/Rs.31740/Rs.26760/Rs.29100/Rs.29100/Rs.27120/Rs.24000/Rs. 31080/Rs.36960/- CODE 01020014 01020015 01020016 01020017 Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Thoracoscopic Lobectomy Thoracoscopic Segmental Resection Thoracoscopic Hydatid Cyst excision Thoracoscopic Sympathectomy 021 - Cardiac / Cardio Thoracic Procedures Coronary Bypass Surgery Coronary Bypass Surgerypost Angioplasty Coronary Balloon Angioplasty Balloon angioplasty with Valvotomy Open Heart Procedures Total Correction of Tetralogy of Fallot RSUV Correction TAPVC Correction Open ASD VSD Open Pulmonary Valvotomy Open Aortic Valvotomy Blalock Taussig Operation Mitral Valvotomy Mitral Valve Replacement Aortic Valve Replacement Double Valve Replacement Valve Closed Valvotomy Coarctation-Arota Repair of Block Taussing Shunt Patent Ductus Arteriousus Mitral Valvotomy (Open) Pericardiostomy Pericardiectomy Pericardio Centesis Permanent Pacemaker Implantation Rs.36960/Rs.36960/Rs.36960/Rs.36960/Rs.150000/Rs.150000/Rs.66000/Rs.90000/Rs.144000/Rs.150000/Rs.150000/Rs.154800/Rs.150000/Rs.150000/Rs.150000/Rs.51000/Rs.72000/Rs.160380/Rs.160380/Rs.139380/Rs.96000/Rs.96000/Rs.96000/Rs.144000/Rs.54000/Rs.72000/Rs.3858/Rs.19380/- 01021001 01021002 01021003 01021004 01021005 01021006 01021007 01021008 01021009 01021010 01021011 01021012 01021013 01021014 01021015 01021016 01021017 01021018 01021019 01021020 01021021 01021022 01021023 01021024 30 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE 01021025 01021026 01021027 01021028 01021029 01021030 01021031 01021032 01021033 01021034 01021035 01021036 01021037 01021038 01021039 01021040 01022001 01022002 01022003 01022004 01022005 01022006 01022007 01022008 01022009 01022010 Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Temporary Pacemaker Implantation Embolectomy Aneurysm- Resection & Grafting Thoracocentesis Thorachostomy Exploratory Thorocotomy Aorta-Femoral Bypass Removal of Foreign Body from Trachea or Oesophagus Rib Resection & Drainage Mediastinal Tumour Thymectomy Partial Pericardectomy Removal Tumours of Chest Wall DSA EP STUDY RF ABLATION 022 - Oesophagus Atresia of Oesophagus and Tracheo Oesophageal Fistula Operations for Replacement of Oesophagus by Colon Oesophagectomy for Carcinoma Easophagus Oesophageal Intubation (Mausseau Barbin Tube) Achalasia Carida Transthoracic Achalasia Carida Abdominal Oesophago Gastrectomy for mid 1/3 lesion Heller's Operation Colon-Inter position or Replacement of Oesophagus Oesophago Gastrectomy Lower Corringers procedure Rs.12600/Rs.19800/Rs.36000/Rs.1939/Rs.14760/Rs.43632/Rs.54000/Rs.4848/Rs.11490/Rs.32520/Rs.30420/Rs.20400/Rs.20400/Rs.5400/Rs.8400/Rs.26400/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) 023 - Abdomen Gastroscopy Gastric & Duodenal Biopsy (Endoscopic) Pyleromyotomy Gastrostomy Simple Closure of Perforated peptic Ulcer Vagotomy Pyleroplasty / Gastro Jejunostomy Duodenojejunostomy Partial/Subtotal Gastrectomy for Carcinoma Partial/Subtotal Gastrectomy for Ulcer Operation for Bleeding Peptic Ulcer Gastrojejunostomy & Vagotomy Operation for Gastrojejunal Ulcer Total Gastrectomy for Cancer Highly Selective Vagotomy Selective Vagotomy & Drainage Congenital Diaphragmatic Hernia Hiatus Hernia Repair Abdominal Hiatus Hernia Repair Transthoracic Exploratory Laparotomy Epigastric Hernia Repair Umbilical Hernia Repair Ventral and Scar Hernia Repair Inguinal Hernia Herniorraphy Inguinal Hernia Hernioplasty Rs.1170/Rs.1560/Rs.8242/Rs.11820/Rs.12120/Rs.27840/Rs.21480/Rs.25200/Rs.25200/Rs.21000/Rs.22786/Rs.21600/Rs.32400/Rs.21000/Rs.22200/Rs.25440/Rs.24960/Rs.24960/Rs.12870/Rs.12540/Rs.12540/Rs.14400/Rs.14940/Rs.17700/- 01023001 01023002 01023003 01023004 01023005 01023006 01023007 01023008 01023009 01023010 01023011 01023012 01023013 01023014 01023015 01023016 01023017 01023018 01023019 01023020 01023021 01023022 01023023 01023024 Rs.29700/Rs.37814/Rs.38016/Rs.15480/Rs.18422/Rs.14544/Rs.26580/Rs.22980/Rs.26520/Rs.19800/- 31 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Femoral Hernia Repair Rare Hernias - Repair (Spigalion, Obturator, Lumbar, Sciatic) Splenectomy - For Trauma Splenectomy - For Hypersplenism Splenorenal Anastomosis Portocaval Anastomosis Direct Operation on Oesophagus for Portal Hypertension Mesentericocaval Anastomosis Warren Shunt Pancerato Duodenectomy By Pass Procedure for Inoperable Carcinoma of Pancreas Cystojejunostomy or Cystogastrostomy Cholecystectomy Cholecystectomy & Exploration of CBD Repair of Common Bile Duct Operation for Hydatid Cyst of Liver Cholecystostomy Hepatic Resections (Lobectomy Hepatectomy) Operation on Adrenal Glands - Bilateral Operation on Adrenal Glands - Unilateral for Tumour Appendicectomy for Acute Appendicitis Appendicectomy for Chronic Appendicitis Rs.18300/Rs.21900/Rs.23640/Rs.23640/Rs.36300/Rs.37800/Rs.27390/Rs.34980/Rs.34980/Rs.36000/Rs.26580/Rs.25500/Rs.14160/Rs.18960/Rs.17400/Rs.22980/Rs.14160/Rs.24240/Rs.33120/Rs.17760/Rs.15900/Rs.13770/01023065 01023066 01023067 01023068 01023069 01023070 CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Appendicular Abscess Drainage Mesenteric Cyst- Excision Peritonioscopy/Laparoscopy Jejunostomy Ileostomy Congenital Atresia & Stenosis of Small Intestine Muconium ileus Mal-rotation & Volvulus of the Midgut Resection & Anastomosis of Small Intestine Excision of Meckle's Deverticulum Duodenal Diverticulum Operation for Intestinal Obstruction Operation for Intestinal perforation Benign Tumours of Small Intestine Excision of Small Intestine Fistual Operations for Haemorrhage of the Small Intestines Operations of the Duplication of the Intestines Operations for Recurrent Intestinal Obstruction (Noble Plication & Other Operations for the Adhesions) Ilieosigmoidostomy Ilieotransverse Colostomy Caecostomy Loop Colostomy Transverse Sigmoid Terminal Colostomy Closure of Colostomy Rs.10800/Rs.14100/Rs.5100/Rs.14640/Rs.24600/Rs.21300/Rs.18420/Rs.19200/Rs.21600/Rs.21480/Rs.14400/Rs.21240/Rs.21300/Rs.20400/Rs.21240/Rs.24120/Rs.28080/- 01023025 01023026 01023027 01023028 01023029 01023030 01023031 01023032 01023033 01023034 01023035 01023036 01023037 01023038 01023039 01023040 01023041 01023042 01023043 01023044 01023045 01023046 01023047 01023048 01023049 01023050 01023051 01023052 01023053 01023054 01023055 01023056 01023057 01023058 01023059 01023060 01023061 01023062 01023063 01023064 Rs.25200/Rs.20640/Rs.20640/Rs.8100/Rs.16620/Rs.20280/Rs.20280/- 32 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Right Hemi-Colectomy Left Hemi-Colectomy Total Colectomy Operations for Volvulus of Large Bowel Operations for Sigmoid Diverticulitis Fissure in Ano - Dilatation Fissure in Ano - Fissurectomy Rectal Polyp-Excision Operation of Haemorrhoids -Lords procedure Fistula in Ano - High Fistulectomy Fistula in Ano - Low Fistulectomy Imperforat Anus Colostomy Imperforate Anus Pull Through Operation Prolapse Rectum Theirch Wiring Prolapse Rectum Rectopexy Prolapse Rectum Grahams Operation Operations for Hirschsprungs Disease Excision of Pilonidal Sinus Abdomino-Perineal Excision of Rectum Anterior Resection of rectum Pull Through Abdominal Resection Operations for Neuroblastoma 024 - Nephrology / Genitourinary Partial Nephrectomy Nephrolithotomy Pyelolithotomy Rs.20280/Rs.19740/Rs.39000/Rs.25200/Rs.21150/Rs.6787/Rs.13200/Rs.6060/Rs.7236/Rs.16920/Rs.10590/Rs.14820/Rs.20760/Rs.12540/Rs.8484/Rs.21720/Rs.21720/Rs.12300/Rs.26640/Rs.26220/Rs.21816/Rs.21816/Rs.21000/Rs.21089/Rs.21089/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Operations for Hydronephrosis Open Drainage of Perinephric Abscess Cavernostomy Operations for Cyst of the Kidney Ureterolithotomy Nephroureterectomy Operations for Ureter for Double Ureters Operations for Ureter -for Ectopia of Single Ureter Operations for Vesicoureteric Reflux Ureterostomy - Cutaneous Uretero-Colic anastomosis Formation of an Ileal Conduit Ureteric Catheterisation Dormia Extraction of Calculus Biopsy of Bladder (Cystoscopic) Diathermy Destruction of Bladder Neoplasm Litholapexy Operations for Injuries of the Bladder Suprapubic Drainage (Cystostomy) Total Cystectomy Diverticulectomy Open Resection of the Bladder Neck Y-V Plasty of the Bladder Neck Cystoplasty Operations for Extrophy of the Bladder Rs.21000/Rs.12120/Rs.20400/Rs.15514/Rs.14400/Rs.14544/Rs.24180/Rs.23700/Rs.24240/Rs.18720/Rs.19392/Rs.19380/Rs.4080/Rs.6000/Rs.6600/Rs.10666/Rs.12600/Rs.20490/Rs.12000/Rs.34980/Rs.29100/Rs.23270/Rs.23270/Rs.26550/Rs.34980/- 01023071 01023072 01023073 01023074 01023075 01023076 01023077 01023078 01023079 01023080 01023081 01023082 01023083 01023084 01023085 01023086 01023087 01023088 01023089 01023090 01023091 01023092 01024004 01024005 01024006 01024007 01024008 01024009 01024010 01024011 01024012 01024013 01024014 01024015 01024016 01024017 01024018 01024019 01024020 01024021 01024022 01024023 01024024 01024025 01024026 01024027 01024028 01024001 01024002 01024003 33 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Repair of Ureterocoel Suprapubic Prostatectomy Retropubic Prostatectomy Transurethral Resection of Prostate (TURP) Urethroscopy Operations for Injury to Urethra Internal urethrotomy Urethral Reconstruction Operation for Congenital Valves of Urethra Operations for Incontinence of Urine - Male Operations for Incontinence of Urine - Female Reduction of Paraphimosis Circumcision Meatotomy Meatoplasty Operations for Hypospadias - Chordee Correction Operations for Hypospadias - Second Stage or One Stage Repair Operations for Epispadias Partial Amputation of the Penis Total amputation of the Penis Orchidectomy Epididymectomy Adreneclectomy Unilateral /Bilateral for Tumour/For Carcinoma Operations for Hydrocele Unilateral Operations for Hydrocele Bilateral Rs.15514/Rs.22320/Rs.23700/Rs.21150/Rs.4830/Rs.30000/Rs.12120/Rs.27600/Rs.13574/Rs.22740/Rs.22740/Rs.2424/Rs.4200/Rs.2424/Rs.6787/Rs.12900/Rs.24000/Rs.19392/Rs.11220/Rs.19320/Rs.11700/Rs.10800/Rs.28200/Rs.6300/Rs.9198/- CODE Maximum NAME OF TREATMENT Approved PROCEDURE Rate (INR) (Rs.) Operation for Torsion of Testis Vasovasostomy Operations for Varicocele Block Dissection of Inguinal Nodes - One Side Block Dissection of Inguinal Nodes - Both Sides Excision of Filarial Scrotum Emergency Dialysis Femoral Puncture Emergency Dialysis Subclavian Puncture Fistula/Shunt Dialysis Femoral Catheterisation Bilateral Haemo Dialysis Double Lumen Sub Clavian Catheter Continuous Arterio Venus Dialysis (CAVD) Subclavian Access Femoral Access Plasma Exchange Donor Nephrectomy Renal Transplantation Ureteric Reimplant Lymphocoel Transplant Nephrectomy Bilateral Nephrouretectomy (Native) Vascular Prosthetic Graft CAPD PCNL - Unilateral PCNL - Bilateral Palomo's Unilateral Palomo's Bilateral Endoscopic Teflon Inject Testicular Biopsy Rs.11880/Rs.15600/Rs.10800/Rs.23100/Rs.30900/Rs.15480/Rs.1200/Rs.1860/Rs.6000/Rs.3660/Rs.1440/Rs.3900/Rs.15480/Rs.1842/Rs.1740/Rs.1200/Rs.28800/Rs.137700/Rs.4200/Rs.4320/Rs.19200/Rs.18600/Rs.12000/Rs.7272/Rs.24120/Rs.34500/Rs.7272/Rs.12600/Rs.5100/Rs.4320/- 01024029 01024030 01024031 01024032 01024033 01024034 01024035 01024036 01024037 01024038 01024039 01024040 01024041 01024042 01024043 01024044 01024045 01024046 01024047 01024048 01024049 01024050 01024051 01024052 01024053 01024054 01024055 01024056 01024057 01024058 01024059 01024060 01024061 01024062 01024063 01024064 01024065 01024066 01024067 01024068 01024069 01024070 01024071 01024072 01024073 01024074 01024075 01024076 01024077 01024078 01024079 01024080 01024081 01024082 01024083 34 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01024084 01024085 01024086 01024087 01024088 01024089 01024090 01024091 01024092 01024093 01024094 01024095 01024096 01024097 01024098 01024099 01024100 01024101 01024102 01024103 01024104 01024105 01024106 01024107 01024108 01024109 01024110 01024111 Gil-Verner's Extended Pyelolithotomy Nephrectomy Complicated Tumour or Adhesions Anderson Hynes Pyeloroplasty Vasico Vaginal Fistula Repair Radical Cystectomy Caeco Cystoplasty Nephrectomy Simple Nephrostomy Ureteric Reimplant Partial Cystectomy TURP & TUR Bladder Tumour TURP Cystolithotripsy Open Prostatectomy Closure of Urethral Fistula Orchidopexy - Unilateral Orchidopexy - Bilateral Cystolithotomy -Suprapubic Endoscopic Removal of Stone in Bladder Resection Bladder Neck Endoscopic Ureteroscopic Removal Cystoscopic Basketing of Urethra Urethroplasty 1st Stage Optical Urethrotomy Exploratory Scrototomy Perineal Urethrostomy Dilatation of Stricture Urethra under G.A. Dilatation of Stricture Urethra without Anesthesia Retroperitoneoscopy Nephrectomy Rs.19500/Rs.22200/Rs.17400/Rs.17100/Rs.29088/Rs.24240/Rs.19392/Rs.19386/Rs.8760/Rs.26520/Rs.19392/Rs.24060/Rs.23270/Rs.20844/Rs.12000/Rs.10656/Rs.13332/Rs.11820/Rs.11635/Rs.12605/Rs.12000/Rs.12120/Rs.11520/Rs.9150/Rs.7272/Rs.3030/Rs.2182/Rs.24600/01024112 01024113 01024114 01024115 01024116 01024117 01024118 01024119 01024120 01024121 01024122 01025001 01025002 01025003 01025004 01025005 01025006 01025007 01025008 01025009 01025010 01025011 01025012 Retroperitoneoscopy partial Nephrectomy Retroperitoneoscopic nephrolithotomy Retroperitoneoscopic pyelolithotomy Retroperitoneoscopic operation for Hyderonephrosis Retroperitoneoscopic surgery for Renal cyst Retroperitoneoscopic ureterolithotomy Retroperitoneoscopic Nephroureteroectomy Laproscopy aassisted orchidopexy Laproscopic operation for varicocele Renal Transplant (including donor work) Lithotripsy 025 - Plastic Surgery Primary Suture of Wound Injection of Keloids Ganglion Injection of Keloids Haemangioma Free Grafts - Wolfe Grafts Free Grafts - Theirech Small Area 5% Free Grafts - Large Area 10% Free Grafts - Very Large Area 20% Skin Flaps - Rotation Flaps Skin Flaps - Advancement Flaps Skin Flaps - Direct- cross Leg Flaps- Cross Arm Flap Skin Flaps - Cross Finger Skin Flaps - Abdominal Rs.25200/Rs.23160/Rs.24264/Rs.26400/Rs.24000/Rs.24000/Rs.24600/Rs.20460/Rs.15120/Rs.150000/Rs.18000/Rs.3180/Rs.2700/Rs.6060/Rs.8100/Rs.8484/Rs.9938/Rs.12362/Rs.8726/Rs.11635/Rs.15514/Rs.15514/Rs.15514/- 35 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01025013 01025014 01025015 01025016 01025017 01025018 01025019 01025020 01025021 01025022 01025023 01025024 01025025 01025026 01025027 01025028 01025029 01025030 01025031 01025032 01025033 Skin Flaps - Thoracic Skin Flaps - Arm Etc. Subcutaneous Pedicle Flaps Raising Subcutaneous Pedicle Flaps Delay Subcutaneous Pedicle Flaps Transfer Cartilage Grafting Reduction of Facial Fractures of Nose Reduction of Facial Fractures of Maxilla Reduction of Fractures of Mandible & Maxilla - Eye Let Splinting Reduction of Fractures of Mandible & Maxilla - Cast Netal Splints Reduction of Fractures of Mandible & Maxilla Gumming Splints Internal Wire Fixation of Mandible & Maxilla Cleft Lip - repair. Cleft Palate Repair Severe Degree Primary Bone Grafting of Cleft Lip Palate Secondary Surgery for Cleft Lip Deformity Secondary Surgery for Cleft Palate Reconstruction of Eyelid Defects - Minor Reconstruction of Eyelid Defects - Major Plastic Surgery of Different Regions of the Ear - Minor Plastic Surgery of Different Regions of the Ear - Major Rs.14400/Rs.15514/Rs.8484/Rs.7752/Rs.8484/Rs.9696/Rs.8940/Rs.13800/Rs.7440/Rs.7440/Rs.7757/Rs.11635/Rs.12390/Rs.13800/Rs.14544/Rs.12605/Rs.11340/Rs.7560/Rs.11940/Rs.8100/Rs.12600/01025040 01025041 01025037 01025038 01025039 01025034 01025035 01025036 Plastic Surgery of the Nose Minor Plastic Surgery of the Nose Major Plastic Surgery for Facial Paralysis (Support with Reanimation) Pendulous Breast Mammoplasty Underdeveloped Breast Mammoplasty After Mastectomy (Reconstruction) Mammoplasty Syndactyly Repair Dermabrasion Face 026 - Orthopaedic Surgery Procedure Application of P.O.P Casts for Upper & Lower Limbs Application of Functional Cast Brace Application of Skin Traction Application of Skeletal Tractions Bandage & Strappings for Fractures Aspiration & Intra Articular Injections Application of P.O.P Spices & Jackets Close Reduction of Fractures of Limb & P.O.P Reduction of Compound Fractures Open Reduction & Internal Fixation of Fingurs & Toes Open Reduction of fracture of Long Bones of Upper / Lower Limb -Nailing & External Fixation Rs.8250/Rs.14160/Rs.22543/Rs.22543/Rs.19877/Rs.19877/Rs.19877/Rs.15960/- 01026001 01026002 01026003 01026004 01026005 01026006 01026007 01026008 01026009 01026010 01026011 Rs.1212/Rs.1697/Rs.1620/Rs.4440/Rs.1140/Rs.960/Rs.3600/Rs.3360/Rs.4350/Rs.9000/- Rs.15029/- 36 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01026012 01026013 01026014 01026015 01026016 01026017 01026018 01026019 01026020 01026021 01026022 01026023 01026024 01026025 01026026 01026027 01026028 01026029 01026030 01026031 01026032 Open Reduction of fracture of Long Bones of Upper / Lower Limb -AO Procedures Tension Band Wirings Bone Grafting Excision of Bone Tumours Superficial Excision of Bone Tumours Deep Excision of Ganglion Excision or other Operations for Scaphoid Fractures Sequestrectomy & Saucerizations -Superficial Sequestrectomy & Saucerizations -Deep Sequestrectomy & Saucerizations -Arthrotomy S.P.Nailing for Fracture Neck Femur Multiple Pinning Fracture Neck Femur Nail Plate Fixations for Fracture Neck Femur A.O.Compression Procedures for Fracture Neck Femur Open Reduction of Fracture Neck Femur Muscle Pedicle Graft and Internal Fixations Close Reduction of Dislocations Open Reduction of Dislocations - Superficial Open Reduction of Dislocations - Deep Open Reduction of Fracture Dislocation & Internal Fixation Neurolysis/Nerve Suture Nerve Repair with Grafting 01026033 Rs.14280/Rs.6000/Rs.14160/Rs.15000/Rs.27780/Rs.4848/Rs.12570/Rs.11400/Rs.21360/Rs.15600/Rs.28800/Rs.30300/Rs.33600/Rs.34200/Rs.31200/Rs.3394/Rs.10560/Rs.20700/Rs.29700/Rs.15000/Rs.19800/01026034 01026035 01026036 01026037 01026038 01026039 01026040 01026041 01026042 01026043 01026044 01026045 01026046 01026047 01026048 01026049 01026050 01026051 01026052 01026053 01026054 01026055 01026056 01026057 Tendon with Transplant or Graft Tendon Lengthening/Tendon Sutures Tendon Transfer Laminectomy, Excision Disc and Tumours Spinal Ostectomy and Internal Fixations Anterolateral Clearance for tuberculosis Antereolateral Decompression and Spinal Fusion Costo Transversectomy Corrective Ostectomy & Internal Fixation - Minor Corrective Ostectomy & Internal Fixation - Major Arthrodisis of - Minor Joints Arthrodisis of - Major Joints Soft Tissue Operations for C.T.E.V. Soft Tissue Operations for Polio Partial Hip Replacement Operations for Brachial Plexus & Cervical Rib Amputations - Below Knee Amputations - Below Elbow Amputations - Above Knee Amputations - Above Elbow Amputations - Forequarter Amputations -Hind Quarter and Hemipelvectomy Disarticulations - Major Disarticulations - Minor Arthrography & Osteomedullography Rs.22200/Rs.13020/Rs.21480/Rs.36000/Rs.40200/Rs.28603/Rs.39240/Rs.27180/Rs.13800/Rs.29100/Rs.14520/Rs.30420/Rs.17850/Rs.18960/Rs.34620/Rs.29573/Rs 13170/Rs.12270/Rs.18900/Rs.20100/Rs.37800/Rs.40680/Rs.21600/Rs.12540/Rs.10440/- 37 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01026058 01026059 01026060 01026061 01026062 01026063 01026064 01026065 01026066 01026067 01026068 01026069 01027001 01027002 01027003 01027004 01027005 01027006 01027007 01027008 01027009 01027010 01027011 01027012 01027013 01027014 01027015 Arthroscopy - Diagnostic Arthroscopy - Operative Soft Tissue Operation on Knee Myocutaneous and Fasciocutaneous Flat Procedures for Limbs Removal of Nails, Wires & Screw Removal of Plates Total Hip Replacement Total Ankle Joint Replacement Total Knee Joint Replacement Total Shoulder Joint Replacement Total Elbow Joint Replacement Total Wrist Joint Replacement 027 - Neuro-Surgery Craniotomy and Evacuation of Haematoma -Subdural Craniotomy and Evacuation of Haematoma -Extradural Evacuation of Brain Abscess Excision of Lobe (Frontal, Temporal, Cerebelium etc.) Excision of Brain Tumours Supratentotial Excision of Brain Tumours Subtentorial Surgery of Cord Tumours Ventriculoatrial / Ventriculoperitoneal Shunt Excision of Cervical InterVertebral Discs Sympathetectomy - Lumbar Sympathetectomy - Cervical Twist Drill Craniostomy Subdural Tapping Ventricular Tapping Abscess Tapping Rs.11100/Rs.24240/Rs.24000/Rs.24000/Rs.6720/Rs.8370/Rs.54000/Rs.147000/Rs.121800/Rs.114000/Rs.114000/Rs.111000/Rs.55200/Rs.48000/Rs.44400/Rs.51600/Rs.48000/Rs.45000/Rs.45000/Rs.30000/Rs.36000/Rs.16800/Rs.3636/Rs.30000/Rs.12540/Rs.3199/Rs.3151/01027016 01027017 01027018 01027019 01027020 01027021 01027022 01027023 01027024 01027025 01027026 01027027 01027028 01027029 01027030 01027031 01027032 01027033 01027034 01027035 01027036 01027037 01027038 01027039 01027040 01027041 01027042 01027043 01027044 01027045 01027046 01027047 01027048 Placement of ICP Monitor Urokinase Therepy for ICH Skull Traction Application Lumber Pressure Monitoring Vascular Malformations Peritoneal Shunt Atrial Shunt Meningo Encephalocoel Meningomyelocoel C.S.F. Rhinorrhaea Cranioplasty Posterior Cervical Dissectomy Anterior Cervical Dissectomy Brachial Plexus Exploration Microsuturing Median Nerve Decompression Peripheral Neurectomy (Tirgeminal) Trigeminal Rhiotomy Cranial Nerve Anastomosis Meningocoele Excision Peripheral Nerve Surgery - Major Peripheral Nerve Surgery Minor Ventriculo-Atrial Shunt (Exclud. Cost of valve) Nerve Biopsy Brain Biopsy Anterior Cervical Spine Surgery with fusion Anterior Lateral Decompression Brain Mapping Cervical or Dorsal Laminectomy Combined Trans-oral Surgery & CV Junction Fusion C.V. Junction Fusion Depressed Fracture Discectomy Endarterectomy Rs.6000/Rs.4800/Rs.3420/Rs.6036/Rs.21600/Rs.13272/Rs.13872/Rs.42000/Rs.42000/Rs.42000/Rs.45000/Rs.29040/Rs.24240/Rs.22920/Rs.11880/Rs.11880/Rs.31500/Rs.16968/Rs.13080/Rs.16968/Rs.7752/Rs.13272/Rs. 8242/Rs. 8242/Rs.34980/Rs.30000/Rs. 2400/Rs.27876/Rs.30906/Rs.36000/Rs.33840/Rs.32358/Rs.24967/- 38 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01027049 01027050 01027051 01027052 01027053 01027054 01027055 01027056 01027057 01027058 01028001 01028002 01028003 01028004 01028005 01028006 01028007 01028008 01028009 01028010 01028011 01028012 01028013 01028014 01028015 01028016 01028017 R.F. Lesion for Trigeminal Neuralgia Spasticity Surgery Spinal Fusion Procedure Spinal Intra Medullary Tumours Spinal Bifida Surgery Major Spina Bifida Surgery Minor Stereotaxic Procedures Trans Sphenoidal Surgery Trans Oral Surgery Trans Cranial Doppler 028 - Vascular Surgery Patch Graft Angioplasty Femoropopliteal by pass procedure Thrombendarterectomy Surgery for Arterial Aneursysm -Distal Abdominal Aorta Surgery for Arterial Aneursysm -Upper Abdominal Aorta Surgery for Arterial Aneursysm -Vertebral Intrathoracic Aneurysm -Aneurysm not Requiring Bypass Techniques Intrathoracic Aneurysm Requiring Bypass Techniques Dissecting Aneurysms Stripping of Short or Long Sephenous Veins Ligation of Ankle Perforators Excision and Skin Graft of Venous Ulcer Venous Thromoectomy Lymphatics Excision of Subcutaneous Tissues In Lymphoedema Vascular Procedure - Major Vascular Procedure - Minor Surgery for Arterial Aneursysm Spleen Artery Rs. 5818/Rs.26400/Rs.37932/Rs.37932/Rs.29040/Rs.20262/Rs.20724/Rs.26400/Rs.37932/Rs. 360/Rs.22800/Rs.34200/Rs.35760/Rs.33936/Rs.26400/Rs.24000/Rs.32880/Rs.39900/Rs.39900/Rs.13200/Rs.17400/Rs.15480/Rs.22080/Rs.27900/Rs.24480/Rs.16800/Rs.40200/01028018 01028019 01028020 01028021 01028022 01028023 01028024 01029001 01029002 01029003 01029004 01029005 01029006 01029007 01029008 01029009 01029010 01029011 01029012 01029013 01029014 01029015 01029016 01029017 01029018 Surgery for Arterial Aneursysm Renal Artery Surgery for Arterial Aneursysm Carotid Surgery for Arterial Aneursysm Main Arteries of the Limb Operations for Acquired Arteriovenous Fistual Congenital Arterio Venous Fistula Operations for Stenosis of Renal Arteries Trendelenburg Operations 029 - Paediatric Surgery Excision of thyroglossal Duct/Cyst Diaphragmatic Hernia Repair (Thoracic or Abdominal Approach) Tracheo Oesophageal Fistula (Correction Surgery) Colon Replacement of Oesophagus Omphalo Mesenteric Cyst Excision Omphalo Mesenteric DuctExcision Meckels Diverticulectomy Omphalocele 1st Stage (Hernia Repair) Omphalocele 2nd Stge (Hernia Repair) Gastrochisis Repair Inguinal Herniotomy Congenital Hydrocele Hydrocele of Cord Torsion Testis Operation Congenital Pyloric Stenosisoperation Duodenal- Atresia Operation Pancreatic Ring Operation Meconium Ileus Operation Rs.40200/Rs.42480/Rs.33420/Rs.26580/Rs.27690/Rs.29875/Rs. 13800/Rs.18907/Rs.24240/Rs.29190/Rs.25890/Rs.19500/Rs.18180/Rs.17700/Rs.16968/Rs.18180/Rs.12000/Rs.12000/Rs.12000/Rs.11400/Rs.13770/Rs.16080/Rs.22200/Rs.33600/Rs.18996/- 39 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01029019 01029020 01029021 01029022 01029023 01029024 01029025 01029026 01029027 01029028 01029029 01029030 01029031 01029032 01029033 01029034 01029035 01029036 01029037 01029038 Malrotation of Intestines Operation Rectal Biopsy (Megacolon) Colostomy Transverse Colostomy Left Iliac Abdominal Perineal Pull Through (Hirschaprugis Disease) Imperforate Anus Low Anomaly -Cut Back Operation Imperforate Anus Low Anomaly - Perineal Anoplasty Inperforate Anus High Anomaly -Sacroabdomino Perineal Pull Through Inperforate Anus High Anomaly - Closure of Colostomy Intususception Operation Choledochoduodenostomy for Atresia of Extra Hepatic Billiary Duct Operation of Choledochal Cyst Nephrectomy for Pyonephrosis Nephrectomy for Hydronephrosis Nephrectomy for -Wilms Tumour Paraortic Lymphadenoctomy with Nephrectomy for Wilms Tumour Sacro- Coccygeal Teratoma Excision Neuroblastoma Debulking Neuroblastoma Total Excision Rhabdomyosarcoma wide Excision Rs.20010/Rs.14970/Rs.17700/Rs.17700/Rs.24240/Rs.11635/Rs.17400/Rs.13200/Rs.9696/Rs.22200/Rs.24240/Rs.24240/Rs.22200/Rs.22200/Rs.22200/Rs.26400/Rs.19800/Rs.20846/Rs.24240/Rs.28116/01030001 01030002 01030003 01030004 01030005 01030006 01030007 01030008 01030009 01030010 01030011 01030012 01030013 01030014 01030015 01030016 01030017 01030018 01030019 01030020 01030021 01030022 01030023 01030024 01030025 01030026 01030027 01030028 01030029 01030030 01030031 030 - Gynae, Operation Charges Abdominal Hysterectomy Vaginal Hysterectomy Myomectomy Vaginoplasty Vulvectomy (Simple/Radical) RVF Repair Other Major Operations Manchester Operations Perineorrhaphy Colporraphy Modified Gilliam Shirodkar's Operation Diagnostic Curettage Fractional Curettage D & C and Cervical Biopsy Polypectomy Other-Minor Operation Excision Vaginal Cyst/ Burtholin Cyst Excision Vaginal Septum Laparoscopy Diagnostic Laparoscopy Sterilisation Laparoscopy Operative Laparoscopy LAVH Drilling of Overy Myomectomy Adhesiolysis Management of Ectopic pregnancy Hysteroscopy ICRE Hysteroscopy Removal of IUCD Hysteroscopy Removal of Septum Hysteroscopy Diagnostic Rs.18000/Rs.18600/Rs.16800/Rs.18780/Rs.22200/Rs.23100/Rs.22200/Rs.19200/Rs.14700/Rs.14400/Rs.16890/Rs.10200/Rs.2666/Rs.3394/Rs.3394/Rs.3540/Rs.3600/Rs.3840/Rs.5818/Rs.6000/Rs.7236/Rs.12000/Rs.22800/Rs.10800/Rs.19740/Rs.17400/Rs.19980/Rs.9422/Rs.4020/Rs.8100/Rs.7272/- 40 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF TREATMENT Approved CODE NAME OF TREATMENT Approved PROCEDURE Rate (INR) PROCEDURE Rate (INR) (Rs.) (Rs.) 01030032 01030033 01030034 01030035 01030036 01030037 01030038 Werthimas Hystrectomy for Cancer cervix Sterilisation Post Pertum Sterilisation Intravaginal Abortion- D & C Abortion- Evacuation MTP- 1st Trimester MTP - 2nd Trimester 031 - Laproscopic Operations In Gen. Surgery / Gastrohepatic / NephroDiagnostic Laproscopy Laproscopic Pyloromyotomy Laproscopic Gastrostomy Laproscopic Closure of Perforated peptic ulcer Laproscopic Vagotomy Pyleroplasty/ gastro jejunostomy Laproscopic umbilical hernia repair Laproscopic ventral hernia repair Laproscopic cystogastrostomy Lap. Cholecystectomy & CBD exploration Lap. Hydatid of liver surgery Lap. Hepatic resection Lap. Assisted small bowel resection Lap. For intestinal obstruction Lap. For intestinal perforation Lap. Assisted Right Hemicolectomy Lap. Assisted left Hemicolectomy Lap. Assisted Total Colectomy Rs.28800/Rs.4622/Rs.5918/Rs.3810/Rs.4200/Rs.3210/Rs.4800/01031018 01031019 01031020 01031021 01031022 01031023 01031024 01031025 01031026 01031027 01031028 01031029 01031030 01031031 01031032 01031033 01032001 01032002 01032003 01033001 01033002 Laproscopic Rectopexy Lap. Assisted Abdominoperineal Resection of rectum Lap. Assisted anterior resection Laproscopic Cholecystectomy Laproscopic Appendicectomy Laproscopic Hernia Repair Laproscopic Hiatus Hernia Repair Laproscopic Adhesiolysis Laproscopic Adrenalectomy Laproscopic Thyroidectomy Laproscopic Spleenectomy Laproscopic Colectomy Laproscopic donor Nephroctomy Infra red coagulation in Haemeroohoids Laproscopic Pyelolithotomy Laproscopic ureterolithotomy 032 - Cobalt 60 Therapy Radical Treatment Palliative Treatment Adjustment Therapy 033 - Linear Accelerators Radical Radiotherapy Linear Palliative Radiotherapy Linear 034 - Brachy Therapy Intracavitary 035 - Interestical (Implant) Head & Neck Breast Soft Tissue Sarcome Rs.25200/Rs.30840/Rs.30840/Rs.23400/Rs.15840/Rs.19800/Rs.23160/Rs 18000/Rs.25200/Rs.25200/Rs.25200/Rs.30840/Rs.25200/Rs.10560/Rs.25200/Rs.22560/Rs.18000/Rs.9600/Rs.14400/Rs.30288/Rs.21600/Rs.1200/Rs.9720/Rs.9600/Rs.12000/- 01031001 01031002 01031003 01031004 01031005 01031006 01031007 01031008 01031009 01031010 01031011 01031012 01031013 01031014 01031015 01031016 01031017 Rs.6570/Rs.16920/Rs.19800/Rs.23760/Rs.21600/Rs.19301/Rs.25200/Rs.27600/Rs.25800/Rs.20460/Rs.21600/Rs.23160/Rs.23160/Rs.23160/Rs.24600/Rs.24600/Rs.30840/- 01034001 01035001 01035002 01035003 41 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum RATES OF IVESTIGATIOINS : CODE NAME OF Approved INVESTIGATION Rate (INR) 02 – INVESTIGATIONS (Rs.) CODE NAME OF INVESTIGATION 001 - GENERAL Aspiration Plural Effusion Diagnostic Abdominal Aspiration Diagnostic Pericardial Aspiration Bone Marrow Aspiration Joints Aspiration Biopsy Skin except Hansens Biopsy Lymphnode Biopsy Liver Lumbar puncture Sternal puncture E.C.G. E.E.G. Stress test (TMT) 002 - E.N.T. Pure Tone Audiogram Impedence & other tests SISI, Tone Decay & Difference times Multiple hearing assessment test to Adults Hearing Aid Selection Hearing Aid Analysis Speech Discrimination Score Speech Assessment Cold Calorie Test for Vestibular function 003 - Eye Refraction/Fundoscopy Ortho-optic check up Maximum Approved Rate (INR) (Rs.) 02001001 02001002 02001003 02001004 02001005 02001006 02001007 02001008 02001009 02001010 02001011 02001012 02001013 02002001 02002002 02002003 02002004 02002005 02002006 02002007 02002008 02002009 Rs.540/Rs.720/Rs.364/Rs.630/Rs.558/Rs.300/Rs.960/Rs.1091/Rs.660/Rs.600/Rs.120/Rs.120/Rs.600/Rs.240/Rs.270/Rs.228/Rs.420/Rs.90/Rs.360/Rs.168/Rs.96/Rs.144/- 02003003 02003004 02003005 02003006 02003007 02003008 02003009 02003010 02003011 02003012 02003013 02003014 02003015 02003016 02003017 02003018 02003019 02003020 02003021 02003022 02003023 02003024 02003025 02003026 02003027 02003028 02003029 02004001 02003001 02003002 Rs.84/Rs.97/02005001 Perimetry/field test Clinical Photography Electrooculogram ERG Flourescein Angioraphy A-Scan Tono Graphy VER Goldmen Perimetry Specular microsopy ---Indo cyaningreen Angiography of Retina Indo cyaningreen Angiography - IRIS Automated Perimetry Corneal endothelial cell count Corneal topography Corneal pachymetry Retinal nerve film analyzer studies Auto Refrectemetry Biometry Ultrasound studies - A Scan Ultrasound studies -- B Scan Retinal/Meter function studies PAN ACUITY METER Laser interferometry EKG, EOG Dacryocystography (DGC) Orbital Angio studies 004 - Physiotheraphy Muscle testing and diagnostic 005 - Dental Intra oral X-ray (Digital) Rs.388/Rs.90/Rs.480/Rs.360/Rs.780/Rs.144/Rs.357/Rs.300/Rs.120/Rs.180/Rs.840/Rs.840/Rs.396/Rs.180/Rs.180/Rs.180/Rs.96/Rs.60/Rs.150/Rs.540/Rs.540/Rs.120/Rs.180/Rs.630/Rs.420/Rs.420/Rs.420/Rs.84/Rs.78/- 42 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF Approved CODE NAME OF Approved INVESTIGATION Rate (INR) INVESTIGATION Rate (INR) (Rs.) (Rs.) 02006001 02006002 02006003 02006004 02006005 02006006 02006007 02007001 02007002 02007003 02007004 02007005 02007006 02007007 02007008 02007009 02007010 02007011 02007012 02007013 02007014 02007015 02007016 02007017 02007018 02007019 02007020 02007021 02007022 006 - Others Upper G.I. Endoscopy Rs.1050/Upper G.I. Endoscopy with Biopsy Rs.1248/Sigmoidoscopy (rigid) Rs.1350/Sigmoidoscopy (flexible) Rs.1110/Oesophagoscopy Rs.1080/Colonoscopy Rs.1740/Fibroptic bronchoscopy Rs.2160/007 - X-Ray (Digital X Ray) Fluroscopy chest Rs.120/Occlusal Rs.131/Abdomen AP or Erect (one film) Rs.126/Abdomen Lateral view (one film) Rs.126/Abdomen for Pregnancy Rs.126/Chest PA view (one film) Rs.126/Chest Oblique or Lateral (One film) Rs.126/Mastoids Rs.144/Extremities, bones & Joints (one film) Rs.132/Pelvis (One film) Rs.126/Paranasal sinuses (One film) Rs.132/T.M. Joints (One film) Rs.132/Abdomen & pelvis for K.U.B. Rs.234/Skull A.P. & Lateral Rs.222/Spine A.P. & Lateral Rs.234/Barium Swallow Rs.690/Sinography/ Sialography Rs.744/Cystography/ Urethrography Rs.1116/Hystero-Salpaingography Rs.1110/Arthrography Rs.840/Retrograde Pyelography Rs.1080/Oral or I.V. Cholecystography Rs.720/02007023 02007024 02007025 02007026 02007027 02007028 02007029 02007030 Barium Enema Rs.1152/Barium Meal Upper or Lower Rs.954/Bronchography Rs.1254/I.V. Urography Rs.1350/Myelography Rs.1498/Pneumo Encephalography Rs.1116/Barium meal Complete Rs.1230/Cerebral/Femoral Angiography Rs.1685/008 - Conventional X-Ray (70% of Digital X-Ray rates) Fluroscopy chest Rs.84/Occlusal Rs.92/Abdomen AP or Erect (one film) Rs.88/Abdomen Lateral view (one film) Rs.88/Abdomen for Pregnancy Rs.88/Chest PA view (one film) Rs.88/Chest Oblique or Lateral (One film) Rs.88/Mastoids Rs.101/Extremities, bones & Joints (one film) Rs.92/Pelvis (One film) Rs.88/Paranasal sinuses (One film) Rs.92/T.M. Joints (One film) Rs.92/Abdomen & pelvis for K.U.B. Rs.164/Skull A.P. & Lateral Rs.155/Spine A.P. & Lateral Rs.164/Barium Swallow Rs.483/Sinography/ Sialography Rs.521/Cystography/ Urethrography Rs.781/Hystero-Salpaingography Rs 777/Arthrography Rs.588/Retrograde Pyelography Rs.756/Oral or I.V. Cholecystography Rs.504/- 02008001 02008002 02008003 02008004 02008005 02008006 02008007 02008008 02008009 02008010 02008011 02008012 02008013 02008014 02008015 02008016 02008017 02008018 02008019 02008020 02008021 02008022 43 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF Approved CODE NAME OF Approved INVESTIGATION Rate (INR) INVESTIGATION Rate (INR) (Rs.) (Rs.) 02008023 02008024 02008025 02008026 02008027 02008028 02008029 02008030 Barium Enema Barium Meal Upper or Lower Bronchography I.V. Urography Myelography Pneumo Encephalography Barium meal Complete Cerebral/Femoral Angiography 009 - Ultrasound Investigations Obstetric First Scan Obstetric Follow up (2nd visit) Upper abdomen First Scan Upper abdomen Follow up (2nd visit) Quick look check-up for IUCD & Infants Total Abdominal survey or Multiple organ study Special procedures & Aspiration etc. Image Intensifiers 010 - Clinical Pathology Urine routine Quantitative Albumin/Sugar Urine Bile Pigment and Salt Urine Urobilinogen Urine Ketones Urine Occult Blood Urine total proteins Urine Sodium Urine Chloride Bence Jones protein Stool routine Stool occult blood Post coital smear examination Rs.806/Rs.668/Rs 878/Rs 945/Rs 1049/Rs.781/Rs.861/Rs.1180/02010014 02010015 Smear analysis Body fluid (CSF/Ascitic Fluid etc.) Chemistry, Sugar, Protein etc. Body fluid for Malignant cells 011 - Haematology Haemoglobin (Hb) Total Leucocytic Count (TLC) Differential Leucocytic Count (DLC) E.S.R. Total Red Cell count Platelet count Reticulocyte count Absolute Eosinophil count Packed Cell Volume (PCV) Peripheral Smear Examination Smear for Malaria parasite Bleeding & Clotting Time Clot Retraction Time R.B.C. Fragility Test L.E. Cell Foetal Haemoglobin (Hb-F) Prothrombin Time (P.T.) Complete Haemogram Bone Marrow Smear Exmination Partial Thromboplastin Glucose 6 Phosphate Dehydrogenase (G, 6PD) 012 - Blood Bank Blood Group & RHO Type Cross match Packed cell preparation Rs.85/- Rs.222/Rs.180/Rs.36/Rs.36/Rs.36/Rs.36/Rs.48/Rs.60/Rs.60/Rs.48/Rs.36/Rs.48/Rs.48/Rs.48/Rs.48/Rs.73/Rs.108/Rs.192/Rs.150/Rs.121/Rs.264/Rs.194/Rs.194/Rs.90/Rs.48/Rs.48/- 02010016 02011001 02011002 02011003 02011004 02011005 02011006 02011007 02011008 02011009 02011010 02011011 02011012 02011013 02011014 02011015 02011016 02011017 02011018 02011019 02011020 02011021 02009001 02009002 02009003 02009004 02009005 02009006 02009007 02009008 02010001 02010002 02010003 02010004 02010005 02010006 02010007 02010008 02010009 02010010 02010011 02010012 02010013 Rs.450/Rs.444/Rs.600/Rs.600/Rs.540/Rs.900/Rs.1230/Rs.660/Rs.48/Rs.48/Rs.48/Rs.48/Rs.48/Rs.48/Rs.96/Rs.90/Rs.90/Rs.84/Rs.48/Rs.48/Rs.85/- 02012001 02012002 02012003 44 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF Approved CODE NAME OF Approved INVESTIGATION Rate (INR) INVESTIGATION Rate (INR) (Rs.) (Rs.) 02012004 02012005 02012006 02012007 02013001 02013002 02013003 02013004 02013005 02013006 02013007 02013008 02013009 02013010 02013011 02013012 02013013 02013014 02013015 02013016 02013017 02013018 02013019 02013020 02013021 02013022 02013023 02013024 02013025 02013026 02013027 02013028 02013029 02013030 02013031 Coomb's Test Direct Rs.145/Coomb's Test Indirect Rs.145/Australia Antigen Rs.194/RHO, Antibody titer Rs.168/013 - Bio-Chemistry Glucose blood Rs.60/Blood Urea Nitrogen Rs.72/Serum Creatinine Rs.78/Serum Uric Acid Rs.84/Serum Bilirubin total & direct Rs.126/Serum Iron Rs.194/Serum Cholesterol Rs.96/Total Iron Binding Capacity Rs.242/Glucose (Fasting & PP) Rs.120/Serum Calcium Rs.97/Serum Phosphorus Rs.96/Total Protein Alb/Glo Ratio Rs.120/S.G.P.T. Rs.96/S.G.O.T. Rs.96/Serum amylase Rs.194/Serum Electrolyte Rs.242/Triglyceride Rs.186/Glucose Tolerance Test (GTT) Rs.290/C.P.K. Rs.242/L.D.H. Rs.181/L.D.-1 Rs.181/LDH & LD-1 Rs.314/Alkaline Phosphatase Rs.97/Acid Phosphatase Rs.121/CK MB Rs.372/T3, T4, TSH Rs.630/HDL Cholestrol Rs.145/LH Rs.360/FSH Rs.372/Prolactin Rs.414/Blood gas analysis Rs.340/02013032 02013033 02014001 02014002 02014003 02014004 Blood gas analysis with electrolytes Cortisol 014 - Histopathology Pap Smear Histopathology Frozen section & Paraffin section Vaginal Cytology for Hormonal evaluation 015 - Bactriology & Serology Smear gram-strain examination Sputum smear A.F.B. stain Vaginal Smear Examination V.D.R.L. Widal test Rheumatoid Factor test Culture & Sensitivity (other specimens) Urine pregnancy test C.R.P. ASO Titer Quantitative H.C.G. Blood culture & sensitivity Vibro cholera culture 016 - Obstetric Cases Examination under anaesthesia Laparoscopy (Gynae) 017 - Biopsies Cervical Lymph Node Auxillary Lymph Node Inguinal Lymph Node Excision/Biopsy of Large Lumph Nodes Excision Biopsy of Ulcers Rs.437/Rs.600/Rs.186/Rs.174/Rs.288/Rs.282/- 02015001 02015002 02015003 02015004 02015005 02015006 02015007 02015008 02015009 02015010 02015011 02015012 02015013 02016001 02016002 02017001 02017002 02017003 02017004 02017005 Rs.73/Rs.73/Rs.73/Rs.84/Rs.120/Rs.138/Rs.150/Rs.150/Rs.169/Rs.194/Rs.302/Rs.194/Rs.169/- Rs.2424/Rs.6060/Rs.1560/Rs.2040/Rs.2040/Rs.2040/Rs.3300/- 45 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. Maximum Maximum CODE NAME OF Approved CODE NAME OF Approved INVESTIGATION Rate (INR) INVESTIGATION Rate (INR) (Rs.) (Rs.) 02017006 02017007 02017008 02017009 02017010 02017011 02017012 02017013 02017014 02017015 02017016 02018001 Excision Biopsy of Superficial Lumps Rs.3600/Incision Biopsy of Growths /Ulcers Rs.1800/Trucut Needle Biopsy Rs.1920/Kidney biopsy Rs.1920/Percutaneous Kidney Biopsy Rs.1920/Spleen Aspiration Rs.1920/Marrow Biopsy (Open) Rs.1932/Muscle Biopsy Rs.1740/Scalene Node Biopsy Rs.1452/Direct Laryngoscopy Rs.5400/Fibroptic Laryngoscopy Rs.3000/018 - Head & Neck Cancer Excisional Biopsies Rs.6000/019 - Cardio Respiratory Procedures Direct Laryngoscopy Rs.4380/Bronchoscopy Rs.2400/Mediastinoscopy Rs.2880/Pleural Biopsy Rs.3630/Thoracoscopy Rs.6600/Pulmonary function test BMR Rs.702/Spirometry Rs.702/Spirometry with Helium Dilution Rs.1620/Spirometry with Helium Dilution with diffusion capacity studies Rs.1620/Pulmonery exercise testing Rs.936/Open Lung Biopsy Rs.18000/Medicistinoscopy(cervical) Rs.10800/Video-assisted thoracoscopy (VATS) Rs.36960/020 - Cardiac / Cardio Thoracic Procedures Test of Pacemaker Rs.582/DSA Rs.5400/02020003 02020004 02021001 02021002 EP STUDY RF ABLATION 021 - Abdomen Gastroscopy Gastric & Duodenal Biopsy (Endoscopic) 022 - Nephrology / Genitourinary Biopsy of Bladder (Cystoscopic) Urethroscopy 023 - Orthopaedic Surgery Procedure Arthrography & Osteomedullography Arthroscopy - Diagnostic 024 - Neuro-Surgery Placement of ICP Monitor Lumber Pressure Monitoring Nerve Biopsy Brain Biopsy Brain Mapping 025 - Paediatric Surgery Rectal Biopsy (Megacolon) 026 - Gynae, Operation Charges Diagnostic Curettage Fractional Curettage D & C and Cervical Biopsy Laparoscopy Diagnostic Hysteroscopy Diagnostic 027 - Laproscopic Operations In Gen. Surgery / Gastrohepatic / NephroDiagnostic Laproscopy Rs.8400/Rs.26400/Rs.1170/Rs.1560/- 02022001 02022002 Rs.6600/Rs.4830/- 02023001 02023002 02024001 02024002 02024003 02024004 02024005 02025001 Rs.10440/Rs.11100/Rs.6000/Rs.6036/Rs.8242/Rs.8242/Rs.2400/Rs.14970/- 02019001 02019002 02019003 02019004 02019005 02019006 02019007 02019008 02019009 02019010 02019011 02019012 02019013 02026001 02026002 02026003 02026004 02026005 Rs.2666/Rs.3394/Rs.3394/Rs.6000/Rs.7272/- 02020001 02020002 02027001 Rs.6570/- 46 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE NAME OF INVESTIGATION 028 - Specialised Procedures / Investigations Cat Scan (C.T.) Head Without Contrast Cat Scan (C.T.) Head with Contrast C.T. Head Scan Involv. Spl. Investigation - Without Contrast C.T. Head Involv. Spl. Investigation -with Contrast C.T. Chest (HRCT) Without Contrast C.T. Chest (HRCT) - with Contrast C.T. Spine(Cervical, Dorsal,Lumbar,Sacral) Without Contrast C.T. Spine (Cervical, Dorsal,Lumbar,Sacral) with Contrast C.T. Cervical C.T. 3D Reconstruction only -C.T. Guided Biopsy C.T. Guided percutaneous cath drainage C.T. Myelogram (Cervical Spine) - Without Contrast C.T. Myelogram (Cervical Spine) - with Contrast C.T. Myelogram (Lumbar Spine or D/S) - Without Contrast C.T. Myelogram (Lumbar Spine or D/S)- with Contrast C.T. Scan Brain - Without Contrast C.T. Scan Brain - with Contrast Maximum Approved Rate (INR) (Rs.) CODE NAME OF INVESTIGATION C.T. Scan Chest - Without Contrast C.T. Scan Chest - with Contrast C.T. Scan Upper Abdomen - Without Contrast C.T. Scan Upper Abdomen - with Contrast C.T. Scan Lower Abdomen - Without Contrast C.T. Scan Lower Abdomen - with Contrast C.T. Scan Whole Abdomen - Without Contrast C.T. Scan Whole Abdomen - with Contrast C.T. Scan Neck (Thyroid Soft Tissue) Without Contrast C.T. Scan Neck (Thyroid Soft Tissue) with Contrast C.T. Scan Orbits Without Contrast C.T. Scan Orbits with contract C.T. Scan Limbs Without Contrast C.T. Scan Limbs with Contrast C.T. Scan Whole Body Without Contrast C.T. Scan Whole Body with Contrast C.T. Scan of Para Nasal Sinus - Without Contrast C.T. Scan of Para Nasal Sinus - with Constrast 029 - MRI MRI Head - Without Contrast Maximum Approved Rate (INR) (Rs.) Rs.2790/Rs.2988/Rs.2510/Rs.3120/Rs.2510/Rs.3120/Rs.5022/Rs.5670/Rs.2328/Rs.2832/Rs.2328/Rs.2358/Rs.2790/Rs.2280/Rs.10080/Rs.14400/Rs.2280/Rs.3456/- 02028018 Rs.1620/Rs.1890/Rs.2304/Rs.2574/Rs.2790/Rs.2988/Rs.2790/02028027 Rs.2988/Rs.1200/Rs.1860/Rs.2418/Rs.3070/Rs.3930/Rs.3070/Rs.3930/Rs.1620/Rs.1890/02029001 02028028 02028029 02028030 02028031 02028032 02028033 02028034 02028035 02028019 02028020 02028021 02028022 02028023 02028024 02028025 02028026 02028001 02028002 02028003 02028004 02028005 02028006 02028007 02028008 02028009 02028010 02028011 02028012 02028013 02028014 02028015 02028016 02028017 Rs.6000/- 47 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE NAME OF INVESTIGATION MRI Head - with Contrast MRI Orbits - without Contrast MRI Orbits - with Contrast MRI Nasopharynx and PNS Without Contrast MRI Nasopharynx and PNS with Constrast MRI Neck - Without Contrast MRI Neck - with Contrast MRI Shoulder - Without Contrast MRI Shoulder - with Contrast MRI Shoulder both Joint Without Contrast MRI Shoulder both Joint with Contrast MRI Wrist - Without Contrast MRI Wrist - with Contrast MRI Wrist both Joint Without Contrast MRI Wrist both Joint with Contrast MRI Knee Joint - Without Contrast MRI Knee Joint - with Contrast MRI Knee both Joint Without Contrast MRI Knee both Joint with Contrast MRI Ankle - Without Contrast MRI Ankle - with Contrast MRI Ankle Both - Without Contrast Maximum Approved Rate (INR) (Rs.) Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/- CODE NAME OF INVESTIGATION MRI Ankle Both - with Contrast MRI Hip - Without Contrast MRI Hip - with Contrast MRI Pelvis - Without Contrast MRI Pelvis - with Contrast MRI Extremities - Without Contrast MRI Extremities - with Contrast MRI Temporomandibular Single Joint - Without Contrast MRI Temporomandibular Single Joint - with Contrast MRI Temporomandibular Double Joints - Without Contrast MRI Temporomandibular Double Joints - with contrast MRI Abdomen - Without Contrast MRI Abdomen - with Contrast MRI Breast - Without Contrast MRI Breast - with Contrast MRI Spine Screening Without Contrast MRI Spine Screening with Contrast MRI Chest - Without Contrast MRI Chest - with Contrast MRI Cervical Spine Without Contrast MRI Cervical Spine - with Contrast Maximum Approved Rate (INR) (Rs.) Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/Rs.5400/Rs.9600/Rs.6000/Rs.9600/Rs.6000/Rs.9600/- 02029002 02029003 02029004 02029005 02029006 02029007 02029008 02029009 02029010 02029011 02029012 02029013 02029014 02029015 02029016 02029017 02029018 02029019 02029020 02029021 02029022 02029023 02029024 02029025 02029026 02029027 02029028 02029029 02029030 02029031 02029032 02029033 02029034 02029035 02029036 02029037 02029038 02029039 02029040 02029041 02029042 02029043 02029044 48 Annexure- B (Notification No. 3473-F dt 11.05.09.) Rate list for Health Care Organizations empanelled under the West Bengal Health Scheme 2008. CODE NAME OF INVESTIGATION MRI Lumber Spine Without Contrast MRI Lumber Spine - with Contrast MRI Screening - Without Contrast MRI Screening - with Contrast MRI Angiography - Without Contrast MRI Angiography - with Contrast 030 - Other Investigations Mammography (Single side) Mammography (Both sides) Bone Densitometry Single site Bone Densitometry Two sites Bone Densitometry Three sites ( Spine , Hip & one extremity) Bone Densitometry Whole body 2 D Echo with colour Doppler Trans Oesophaedral Echo (TEE) Holter Analysis & Holter Report (with Prd. Specification) Fluoroscopic Screening Oxygen Saturation Cardiac Cath Angiography (Without Coronary Angioplasty) Aortogram Package charges for Cardiovascular investigation Maximum Approved Rate (INR) (Rs.) Rs.6000/Rs.9600/Rs.5400/Rs.8400/Rs.6000/Rs.6000/Rs.540/Rs.648/Rs.720/Rs.1080/Rs.1440/Rs.1800/Rs.1320/Rs.840/Rs.1470/Rs.120/Rs.120/Rs.13200/Rs.3900/Rs.408/- CODE NAME OF INVESTIGATION Maximum Approved Rate (INR) (Rs.) 02029045 02029046 02029047 02029048 02029049 02029050 02030015 02030016 02030017 02030018 02030019 02030020 02030021 02030022 02030023 02030024 02030025 02030026 02030027 02030028 02030029 02030030 02030031 02030032 02030033 02030034 Fibroptic Bronchoscopy with Washing/Biopsy Rs.1800/Uroflow Study (Micturometry) Urodynamic Study (Cystometry) Cystoscopy with Retrograde Catheter Unilateral Cystoscopy with Retrograde Catheter Bilateral Cystoscopy Diagnostic Cystoscopy with Bladder Biopsy Cortisol-blood Voiding-cysto-urethrogram Renal Transplant Evaluation Whole body scan Spect bone Scan Bone Marrow Scan Scan (Spect) Stress Thallium Muga (Resting) Muga (Stress) A.V. Fistula Coronary Angiography Prostrate Specific Antigen (PSA) Rs.276/Rs.360/Rs.2400/Rs.3600/Rs.480/Rs.2400/Rs.240/Rs.360/Rs.840/Rs.1939/Rs.2640/Rs.1800/Rs.2885/Rs.3600/Rs.1440/Rs.1800/Rs.3000/Rs.11700/Rs.500/- 02030001 02030002 02030003 02030004 02030005 02030006 02030007 02030008 02030009 02030010 02030011 02030012 02030013 02030014 Room Rent per day (inclusive of all diet, nursing, linen, electricity & water charges, monitoring, clinical care provision) General Ward : Semi Private Ward : Private Ward : Day Care (all categories) : Rs.600/Rs.1200/Rs.1800/Rs.600/- 49 Government of West Bengal Finance Department Audit Branch No: 3474 F dt. : 11.05.09. Memorandum The State Govt. employees and their family members are entitled to the medical facilities under the West Bengal Services (Medical Attendance) Rules, 1964, as amended from time to time. To provide better medical facilities to the State Govt. employees and their family members a liberalized medical assistance Scheme in the name “the West Bengal Health Scheme, 2008” has been introduced under notification no. 7287-F dt.19. 09.2008. It has come into force w.e.f. 01.06.2009 as notified under no. 3472 F dt 11.05.09. List of hospitals and approved rates have been notified under no. 3473 F dt. 11.05.09. An employee who wants to get benefits of the Scheme for himself and his/her family members in addition to the facilities entitled under the West Bengal Services (Medical Attendance) Rules, 1964, as subsequently amended shall have to furnish option in form ‘A’ in duplicate appended to the Scheme and he/she will not be entitled to draw regular medical allowance with effect from the date of enrolment under the Scheme. Detailed procedure as laid down in clause-4 of the Scheme should be followed for enrolment. Note: If husband and wife both are Govt. employees under the Govt. of West Bengal and if one opts under the Scheme, both will not be entitled to draw regular medical allowance. (2) In these orders‘Eligible Govt. Employee’ means a Govt. employee enrolled under the West Bengal Health Scheme, 2008. (3) Family : (a) For availing medical facilities under the West Bengal Health Scheme, 2008, children, minor brothers, minor sisters, parents as defined in clause-3(e) of the Scheme, shall be deemed to be dependent on the Govt. employee if they are normally residing with him/her and fulfills the conditions of income. Note: (i) ‘Son’ is considered to be dependent till he starts earning or attains the age of 25 years, whichever is earlier. Son suffering from permanent disabilities either physically or mentally will be considered dependent without any age limit. (ii) Unmarried daughter is eligible till she starts earning (irrespective of age). (iii) As an exception, parents can live away from employee in another station with other members of family. (iv) A declaration regarding the income of parents should be furnished by the employee concerned once at the beginning of every calendar year. (b) it is the responsibility of the employee concerned to apply for deletion of the name of any dependent member of his/ her family from the Scheme, when the ward is no longer entitled to the benefits eligible under the Scheme. The failure on the part of the Govt. employee to get the name of the 50 child deleted from the Scheme when he/she is no longer dependent on him/her will amount to suppression of fact and it will be treated as a good and sufficient reason for initiating disciplinary proceedings against him/her in terms of the W.B.S. (C.C.A.) Rules, 1971 as amended. (4) Hospitals/ Nursing Homes/ Diagnostic Centres : Apart from the Govt. Hospitals, Hospitals run by Municipal Corporations, Municipalities and other Local Bodies and State-aided Hospitals, the Private Hospitals, Nursing Homes, Institutions, Clinics, Laboratories, Diagnostic Centres, etc. as per list attached in annexure ‘A’ of the notification no. 3473 F dt. 11.05.09 are recognized for the purpose of the West Bengal Health Scheme, 2008. An eligible Govt. employee/ beneficiary shall show his/her Identity Card to the hospital/ diagnostic centre where he/ she intends to get medical attendance and treatment. The hospital/ diagnostic centre shall provide accommodation etc. as per entitlement as mentioned in clause -8 of the Scheme and provide medical services/ procedures, as are essential, to the Govt. employee/ beneficiary under memorandum of agreement (copy of MOA attached at Annexure-C) and shall charge for such services procedures/ investigations as per agreed rates. The beneficiary shall pay the costs to the Hospital/ Nursing Home/ Diagnostic Centre. However, in case of emergency, the Hospital shall not refuse admission or demand for advance from the eligible Govt. employee or his/her family members. The final bill shall be settled by the beneficiary before discharge. Any legal liability arising out of such services shall be the sole responsibility of the concerned empanelled hospital/ diagnostic centre and the same shall be dealt with by the concerned empanelled hospital/diagnostic centre. Note : Private Hospitals/ Nursing Homes/ Diagnostic Centres, etc. have been classified into three classes (vide annexure A of the notification no 3473 F dt. 11.05.09). The rates to be charged by these Service Providers from the Govt. employees shall be as follows: (i) Class-1 service provider: 100% of approved rates or actual rate of the service provider, whichever is less. (ii) Class-2 service provider: 80% of approved rates or actual rate of the service Provider, whichever is less. (iii) Class-3 service provider: 70% of approved rates or actual rate of the service Provider, whichever is less. (5) Approved Rates : Rates for reimbursement of medical expenses for various treatments/ tests/ procedures have been specified under the Finance Department notification no. 3473 F dt. 11.05.09 (Annexure- ‘B’). Private Hospitals, Diagnostic Centres, etc. shall charge for medical attendance and treatment of a beneficiary on the basis of approved rates or actual rates of the concerned hospital, whichever is less. For indoor treatment, Private Hospitals/ Diagnostic Centres shall charge medical expenses on the basis of package rate. “Package rate” means and includes lump sum cost of in-patient treatment/day care/diagnostic procedures, etc. Package rate includes: (i) (ii) Registration charges, Admission charges, 51 (iii) (iv) (iv) (v) (vi) (vii) (ix) (x) (xi) (xii) (xiv) (xv) (xvi) Accommodation charges including patients’ diet, Operation charges, Injection charges, Dressing charges, Doctor/ consultant charges, ICU/ ICCU charges, Monitoring charges, Transfusion charges, Anaesthesia charges, Operation theatre charges, Cost of surgical disposables and all sundries used during hospitalization, Cost of medicines, Related routine and essential investigations, (xiii) Procedural charges/ surgeon’s fee, (xvii) Physiotherapy charges etc, and (xviii) Nursing care and charges for its services but excluding expenses on telephone, tonics, toiletries, cosmetics, etc. Package rate does not include cost of implants. The reimbursement of the cost of implants is admissible as per approved W.B.H.S., 2008 rates for implants or as per actuals in case there is no prescribed ceiling. In case, no “package deal” is possible, costs may be calculated for medical attendance, medicines, investigations, bed charges and procedures, etc as per approved rates/ actuals. Note: Actual cost of Pacemaker, coronary stents, heart valves, Intra-ocular Lens, various artificial appliances, Neuro-implants will be reimbursed in full. But when use of a dual-chamber Pacemaker or use of more than two stents or use of more than one drug eluting stent is essential, prior permission of the West Bengal Health Scheme Authority under the Finance Department should be obtained. (6) Facilities: An eligible employee or a family member of an eligible employee shall be entitled to the following facilities, namely: (a) Medical attendance and treatment as an indoor patient in a recognized hospital or institution; and (b) Medical attendance and treatment at out patient department of a recognized hospital or an institution, or a clinic attached to such hospital or institution. Reimbursement of the cost in the above cases shall be allowed in terms of clauses 6, 7 & 9 of the West Bengal Health Scheme, 2008. 52 An employee or beneficiary shall be entitled to accommodation in the case of medical attendance and treatment as an indoor patient as per clause-8 of the Scheme. Note: (i) Normally, the treatment in higher category of accommodation than the entitled category shall not be permissible. However, in case of emergency when the entitled category of accommodation is not available, admission to immediate higher category may be allowed till the entitled category of accommodation becomes available. However, if a particular hospital does not have the ward as per entitlement of the employee, the hospital may only make bill as per the entitlement of the employee even though the treatment was given in a higher type of accommodation. (ii) If, on request of the employee/ beneficiary, treatment is provided in a higher category of accommodation other than that of entitled class, the expenditure, over and above the entitlement, shall be borne by the employee/ beneficiary. (7) Identity Cards: Blank identity cards shall be supplied by the Medical Cell under the Finance Department. Cadre Controlling Departments or the Heads of offices through the Administrative Departments shall place requisition for supply of blank cards. Identity Cards may be issued to a Govt. employee and his/ her family members following Clause-10 of the Scheme. G.P.F. number shall be used as code number of the employee. Example: If an employee has four family members, including himself : (a) Identification number of the employee shall be: G.P.F. No. / 1/ 4. (b) Identification number of wife may be: G.P.F. No. of employee/ 2/ 4. (c) Identification number of another beneficiary may be: G.P.F. No. of employee/ 3/ 4. (d) Identification number of remaining beneficiary may be: G.P.F. No of employee/ 4/ 4. A list of employees to whom identity cards have been issued shall be forwarded to the Finance Department through the concerned Administrative Department. (8) Intimation of Medical Attendance and Treatment : An employee shall give intimation to the Cadre Controlling Department or the Head of Office within due time as mentioned in Clause- 11 of the Scheme. Such intimation is vital for settlement of claims for reimbursment. (9) Settlement of Claims : An eligible Govt. employee under the West Bengal Health Scheme, 2008 should make an application to the concerned authority as mentioned in Clause-12 of the Scheme preferring claim for reimbursement of medical expenditure and settlement of advance, if any, within the specified period of three months of the completion of treatment. The respective Department, the Directorate or the office, as the case may be, to which the employee is attached shall examine and settle the medical claim following Clause-13 of the Scheme. The expenditure shall be met from the head “12- Medical Reimbursement under the West Bengal Health Scheme, 2008” subordinate to the concerned head of account under which his/ her salary is drawn. While settling a claim following guidelines may be followed: 53 (i) For treatment within the State in Govt. hospital/ Govt. aided hospital or recognised Private hospitals vide Annexure-A of the Finance Department notification no. 3473 F dt. 11.05.09 the treatmentcost may be reimbursed on the basis of approved rates given in Annexure- B of the Finance Department notification no. 3473 F dt. 11.05.09 or the actual cost, whichever is less. Class of the Service Provider (Hospitals/ Diagnostic Centres) should be taken into account for reimbursement of the costs. All the Private hospitals/ diagnostic centres mentioned in Annexure-‘A’ have signed agreement on the basis of Memorandum of Agreement (MOA) (copy of MOA attached at Annexure-C) with the Authority of the West Bengal Health Scheme under the Finance Department, Govt. of West Bengal about recognition and the rates for various medical procedures/ tests/ investigations. The MOA signed with the hospitals also includes the ceiling rates quoted/ offered by the hospital/ diagnostic centre. If the rates quoted by the hospital are lower than the ceiling rates given in Annexure-B, the reimbursement may be allowed on that lower rates. (ii) No consultation with the Health and Family Welfare Department and the Finance Department will be necessary for reimbursement of the cost of treatment as indoor patient or as outdoor patient in the recognized hospitals. (iii) No reimbursement may be allowed for treatment taken from unrecognized Private hospitals/ Nursing homes. (iv) Cost of medicines are reimbursable in full except preparations classified as food, tonics, vitamins, disinfectants, toilet preparations, cosmetic items, telephone calls, etc. Charges for pathological and radiological investigations, cost of devices, implants, etc. as are considered essential and not included in the Package are reimbursable in full. (v) Special nursing/ Aya/ Attendant charges are reimbursable in full. (vi) Blood transfusion charges are reimbursable in full but cost of blood is reimbursable as per State Govt. Hospital rate. (vii) Where an eligible Govt. employee has taken a Medical Insurance Policy would be allowed to claim reimbursement of medical expenses both from insurance company as well as the West Bengal Health Scheme, 2008 subject to the observance of the following procedure: A medical claim against the original vouchers/ cash-memos would be raised by the employee first from the insurance company who would issue a certificate to the Cadre Controlling Authority/ Head of Office of the amount reimbursed to the employee. He would then prefer his medical claim along with photo copies of vouchers/ cash-memos to the concerned office. The Cadre Controlling Authority/ Head of Office would then reimburse to the employee only the balance admissible amount on the basis of approved rates i.e., admissible amount minus the amount reimbursed by the insurance company. (10) Treatment in a Hospital or Institution outside the State: Eight Speciality Hospitals outside the State have been recognized for the purpose of the West Bengal Health Scheme, 2008 (vide notification no. 3473 F dt. 11.05.09). For treatment in those hospitals prior permission of the Secretary of the department shall be required. Such permission may be given when treatment in such a hospital is essential and referred by a recognized hospital. West Bengal Health Scheme Authority under the Finance Deptt. may be consulted, where necessary. 54 Reimbursement of the Costs of medical attendance and treatment in a recognized hospital outside the State may be made to the eligible Govt. employee following Clause-14 of the scheme. Cost of journey with one attendant, both ways, as per entitled class of T.A. Rules may be reimbursed to the employee. (11) Medical AdvanceAdvance for medical treatment may be granted to the eligible Govt. employee following Clause-15 of the West Bengal Health Scheme, 2008. D.D.O.S. may draw the advance in A.C. Bill to avoid delay. Adjustment of advance may be done as per rules. Each Department/Cadre Controlling Authority/ Head of Office shall maintain records for monitoring the adjustment of the advance granted to the employee. (12) Role of Administrative Departments (through Cadre Controlling Authority/ Head of Office) : (i) Assessment for budgetary requirementEach department will assess the requirement of fund under the head “12-Medical Reimbursement under the West Bengal Health Scheme,2008” and place their demand to the West Bengal Health Scheme Authority under the Finance Department (Medical Cell) at Ground Floor, Main Block, Writers Building, Kolkata-1. (ii) Issue of Identity CardsBlank identity cards should be collected from the Medical Cell, Finance Department. (iii) Processing of application for advance and (iv) Settlement of claims. Dipankar Mukhopadhyay Principal Secretary to the Government of West Bengal 55 Government of West Bengal Finance Department Audit Branch No: 3475 F Memorandum The State Government pensioners and their family members are entitled to the medical facilities under the West Bengal Services (Medical Benefits for the State Government Pensioner) Rules, 1998 as amended from time to time. Very often Pensioners find it difficult to get treatment for themselves and their family members in Govt. hospitals for want of accommodation. As a result, the State Govt. Pensioners and their family members are forced to get admission in Private hospitals/ Nursing homes and in such cases no reimbursement of cost of treatment is admissible as per the said rules. Even if admission can be acquired in Govt. hospital, reimbursement of cost of medicines purchased from outside and cost of devices procured for treatment is extremely inadequate. (2) Considering the problems faced by the State Govt. Pensioners/ family pensioners in the matter of medical attendance and treatment as well as reimbursement of the medical expenses it was decided to extend the benefits of the West Bengal Health Scheme, 2008 to the State Government Pensioners and their family members (Clause- 16 of the West Bengal Health Scheme, 2008). Now the Governor is pleased to extend the benefits of the West Bengal Health Scheme, 2008, in addition to the West Bengal Services (Medical Benefits) Rules, 1998, as subsequently amended, to the State Government Pensioners and their family members with effect from 01/06/2009. (3) In these orders: (i) “State Government Pensioner or family pensioner” means pensioners who are drawing/ entitled to draw pension/family pension w.e.f. 01.06.2009. (ii) “Pension” means the basic pension inclusive of commuted portion, if any. It covers all classes of pensions under The West Bengal Services (Death-Cum-Retirement Benefit) Rules, 1971 as amended from time to time or any other rules as issued by the Government of West Bengal for the employees under this State Government from time to time. (iii) “family pension” means basic family pension/ex-gratia family pension/ad-hoc family pension/ extraordinary family pension due on 01.06.09 under the West Bengal Services (Death-CumRetirement Benefit) Rules,1971, the West Bengal Services (Extraordinary Pension) Rules, 1971 or Family Pension Scheme, 1965. (iv) “beneficiary” means a member of the family of a State Government pensioner. (v) "family", in relation to a State Govt. Pensioner, means(a) children including step-children and unmarried daughters, (b) dependent minor brothers, (c) dependent minor sisters, dt. : 11.05.09. 56 (d) father or mother whose family income does not exceed rupees one thousand five Hundred p.m., (e) wife or husband, as the case may be ; Note: (i) Son is considered to be dependent till he starts earning or attains the age of 25 years whichever is earlier. Son suffering from permanent disabilities either physically or mentally will be considered dependent without any age limit. (ii) Unmarried daughter is eligible till she starts earning (irrespective of age). (iii) It is the responsibility of the Pensioner concerned to intimate the Pension Sanctioning Authority when a ward is no more entitled to the benefits eligible under the West Bengal Health Scheme, 2008. (vi) 'Eligible State Govt. Pensioner' means a State Govt. Pensioner enrolled under the West Bengal Health Scheme, 2008. (4) Enrolment: (i) The provision of enrolment under the Scheme shall be optional. (ii) A State Govt. Pensioner/ Family pensioner shall not be entitled to draw regular medical relief with effect from the date of effect of such enrolment. (iii) A State Govt. Pensioner/ Family pensioner shall have the liberty to opt out of the Scheme of any time. Provided that where a State Govt. Pensioner/ Family pensioner or any family member has enjoyed any benefit under the Scheme, such pensioner shall not be allowed to opt out of the Scheme within five years from the month following the month in which he/ she enjoyed the benefit. (iv) A State Govt. Pensioner/ family pensioner seeking enrolment under the West Bengal Health Scheme, 2008 shall exercise option in Form No-I in duplicate along with an undertaking that upon enrolment under the Scheme such Pensioner/ Family pensioner shall forgo the regular medical relief drawn along with monthly pension. (v) The option referred to Sub-para (iv) shall be submitted to the Pension Sanctioning Authority. The Pension Sanctioning Authority after scrutinizing the option exercised by the pensioner shall issue a certificate of enrolment in Form-II in favour of the Pensioner/ Family pensioner to be effective from the first day of the month following the month in which the certificate is issued. (vi) The Pension Sanctioning Authority shall send one copy of the certificate to the concerned Pay and Accounts Office/ Treasury with a direction to discontinue the drawal of regular medical relief with effect from the first day of the month following the month in which the certificate is issued. (5) Facilities: An eligible State Govt. Pensioner and his/ her family members/ Family pensioner shall be entitled to the same medical attendance and treatment facilities as entitled by the State Government employees under clauses 5, 6, 7, 9 and 14 of the West Bengal Health Scheme, 2008. (6) Accommodation: In the case of medical attendance and treatment as an indoor patient in a hospital or an institution, an eligible State Govt. Pensioner/ family pensioner or beneficiary shall be entitled to such accommodation as mentioned in column- (4) of the table below, of the category of the state Govt. Pensioner as mentioned in 57 column- (2) to be determined on the basis of Basic Pay (Band Pay including Grade Pay) which he/ she drew before retirement or basic pension in column- (3) respectively, against the Sl. No as mentioned in column(1) of the said table:Table Sl. No. (1) 1. 2. 3. Category of Pensioner (2) I II III Basic Pay (Band Pay including Grade Pay) drawn before retirement/ Basic Pension (3) Above Rs. 27,000 p.m. / Rs. 13,500 p.m. Rs. 18,000 p.m. and above but below Rs. 27,000 p.m. / Rs. 9,000- Rs. 13,500 p.m. Below Rs. 18,000 p.m./ Rs. 9,000 p.m. Type of Accommodation (4) Private Ward Semi-Private Ward General Ward Where the type of accommodation in a hospital does not correspond to the nomenclature as referred to column (4) of the table or any similar nomenclature, the Government shall, in consultation with the hospital authority, determine the entitlement of the beneficiary. (7) Issue of Identity Card to Pensioner and Family Members: (i) The eligible pensioner and his/her family members shall be issued a photo-identity card with a unique identification number under seal and signature of the Pension Sanctioning Authority. (ii) The identification number of the Pensioner and beneficiary shall consist of three numbers, for example x/y/z where 'x' denotes the code number of the pensioner (P.P.O. number), 'y' denotes the serial number of the beneficiary belonging to the family of the pensioner (it being 1 in case pensioner himself/ herself) and 'z' denotes the total number of cards issued for the family of the pensioner. (iii) The blank identity cards with running serial numbers shall be supplied by the Finance Department on the basis of requisition received from pension sanctioning authorities through the Administrative Departments. (iv) The identity cards shall consist of two parts of which the issuing authority shall retain the first part and second part shall be handed over to the pensioner concerned. (v) A list of eligible Pensioners to whom identity cards have been issued shall be forwarded to the concerned Treasury Officer and also to the Finance Department. (vi) The identity card shall have a standard format and colour of the card shall be(a) yellow, in case of pensioners belonging to Category I mentioned in Table to Para-6; (b) pink, in case of pensioners belonging to Category II mentioned in Table to Para-6; (c) white, in case of pensioners belonging to Category III mentioned in Table to Para-6. (vii) A temporary family permit in Form-VI may be issued to a Pensioner enrolled under the Health Scheme by the Pension Sanctioning Authority for a period of six months, pending issue of photoidentity cards and such temporary family permit shall entitle the pensioner and his/her beneficiary to all the benefits of this scheme. 58 (8) Intimation of medical attendance and treatment: An eligible Pensioner/ Family pensioner shall give intimation (Clause- 11 of the Scheme) within three days of commencement of medical attendance and treatment to the Pension Sanctioning Authority. Where a pensioner himself is undergoing treatment and not in a position to intimate personally, any member of his family may give such intimation. (9) Hospitals/ Nursing Homes/ Diagnostic Centres : Apart from the Govt. Hospitals, hospitals run by Municipal Corporations, Municipalities and other Local Bodies and State-aided Hospitals, the Private Hospitals, Nursing Homes, Institutions, Clinics, Laboratories, Diagnostic Centres, etc. as per list attached in annexure 'A' of the notification no. 3473 F dt. 11.05.09. are recognized for the purpose of the West Bengal Health Scheme, 2008. An eligible Govt. pensioner shall show his/her Identity Card to the hospital/ diagnostic centre where he / she intends to get medical attendance and treatment. The hospital/ diagnostic centre shall provide accommodation etc. as per entitlement as mentioned in para-6 and provide medical services/ procedures, as are essential, to the eligible Govt. pensioner or family members under memorandum of agreement and shall charge for such services procedures/ investigations as per agreed rates. The beneficiary shall pay the costs to the Hospital/ Nursing Home/ Diagnostic Centre. However, in emergency, the Private Hospital shall not refuse admission or demand for advance from the eligible Govt. pensioner or his/her family members. The final bill shall be settled by the beneficiary before discharge. Note : Private Hospitals/ Nursing Homes/ Diagnostic Centres etc. have been classified into three classes (vide annexure A of the notification no. 3473 F dt. 11.05.09.). The rates to be charged by these Service Providers from the eligible Govt. Pensioners shall be as (i) Class -1 service provider: 100% of approved rates or actual rate of the service provider whichever is less. (ii) Class -2 service provider: 80% of approved rates or actual rate of the service provider whichever is less. (iii) Class -3 service provider: 70% of approved rates or actual rate of the service provider whichever is less. (10) Rates : Rates for reimbursement of medical expenses for various treatments/ tests/ procedures have been specified under the Finance Department notification no. 3473 F dt. 11.05.09 (Annexure-B). Private Hospitals, Diagnostic Centres, etc. shall charge for medical attendance and treatment of a beneficiary on the basis of approved rates or actual rates of the concerned hospital whichever is less. For indoor treatment Private Hospitals/ Diagnostic Centres shall charge medical expenses on the basis of package rate. "Package rate" shall mean and include lump sum cost of in-patient treatment/ day care/ diagnostic procedures etc. Package rate includes: (i) Registration charges, (ii) Admission charges, (iii) Accommodation charges including patients diet, (iv) Operation charges, 59 (v) Injection charges, (vi) Dressing charges, (vii) Doctor/ consultant charges, (viii) ICU/ ICCU charges, (ix) Monitoring charges, (x) Transfusion charges, (xi) Anaesthesia charges, (xii) Operation theatre charges, (xiii) Procedural charges/ surgeon's fee, (xiv) Cost of surgical disposables and all sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges etc, and (xviii) Nursing care and charges for its services but excluding expenses on telephone, tonics, toiletries, cosmetics, etc. Package rate does not include cost of implants. The reimbursement of the cost of implants is admissible as per approved W.B.H.S., 2008 rates or as per actuals in case, there is no prescribed ceiling. In case, there is no "package deal" possible costs may be calculated for medical attendance, medicines, investigations, bed charges all procedures etc as per approved rates/ actuals. Note: Actual cost of Pacemaker, coronary stents, heart valves, IOL, various artificial appliances, Neuro implants will be reimbursed in full. But when use of a dual chamber Pacemaker or use of more than two stents or use of more than one drug eluting stent are essential prior permission of the West Bengal Health Scheme Authority under the Finance Department is to be obtained. (11) Claims for reimbursement of the cost of medical attendance and treatment:(i) Application in Form-III for settlement of claim shall be made to the Pension Sanctioning Authority within three months of the completion of the treatment. (ii) The application referred to in sub-clause (i) shall be accompanied by the following documents: (a) Essentiality Certificates in Form IV; (b) Photocopy of the identity card issued to the pensioner, and where the claim relates to a member of the family of the pensioner, photocopy of the identity card issued to such member of the family of the pensioner; (c) All original bills verified by the hospital, laboratory or institution; (d) All original vouchers, cash memos and money receipts; (e) Detailed lists of all medicines, laboratory tests, investigations, procedures, number of doctors' visits, etc. with dates, duly countersigned by an authorized person of the hospital where the 60 beneficiary has received medical attendance and treatment, along with a certificate from such authorized person to the effect that all charges are as per approved rates. In the bill prepared by the hospital, each service, procedure and investigation for which the beneficiary is charged should be specified, along with this reference number in the approved list; (f) Detailed list of all medicines purchased from outside and all laboratory tests, investigations and procedures done in a laboratory, institution or hospital other than the hospital where the patient has received medical attendance and treatment, along with a certificate from an authorized person of the hospital that such medicines had to be purchased or such laboratory tests, investigations and procedures had to be done on the advice of the attending physician of the hospital; (g) Photocopy of the intimation given to the Pension Sanctioning Authority regarding medical attendance and treatment of the eligible pensioner or family member of the pensioner; (h) Check list in form V. (12) Settlement of Claims: The application made under Para-11 for reimbursement of the costs shall be processed by the concerned department, the Directorate or the office, as the case may be, under which the pensioner last worked. Provisions of the Clause-13 of the West Bengal Health Scheme, 2008 shall be applicable for the pensioners. The expenditure shall be met from the head "2071- Pension and other Retirement Benefits- 01- 800- NP002- 12- Medical Reimbursement under the West Bengal Health Scheme, 2008" under the Demand No18. While settling a claim following guidelines may be followed:(i) For treatment within the State in Government hospital/ Govt. aided hospital or recognized Private hospitals/ Institutions, etc as (as mentioned at Annexure-A of the Notification No. 3473 F dt. 11.05.09.) cost of treatment may be reimbursed on the basis of approved rates given in Annexure-B of the Notification No. 3473 F dt. 11.05.09. or the actual cost whichever is less. Class of the Service Provider (Hospitals/ diagnostic centres, etc.) shall be taken into account for reimbursement of the costs. If the rates quoted by the hospitals/diagnostic centres are lower than the ceiling rates given in Annexure- B the reimbursement may be allowed on that lower rates. (ii) No reimbursement shall be allowed for treatment taken from unrecognized Private hospitals/ diagnostic centres. (iii) Costs of medicines are reimbursable in full except preparations classified as food, tonic, vitamin, disinfectant, toiletry, cosmetic items and telephone charges. Charges for pathological and radiological investigations are also reimbursible if not included in package rate. Cost of devices, implants, etc. are also reimbursible. (iv) Special Nursing/ Aya/ Attendant charges are reimbursible in full. (v) Blood transfusion charges are reimbursible in full but cost of blood is to be reimbursed as per State Govt. Hospital rates. 61 (13) Treatment in a hospital or institution outside the State: Eight Speciality Hospitals outside the State have been recognized for the purpose of the West Bengal Health Scheme, 2008 (vide Notification No. 3473-F dt. 11.05.09.). Reimbursement of the Cost of treatment may be allowed following clause-14 of the West Bengal Health Scheme, 2008. For treatment in a recognized hospital outside the State permission from the Secretary of the Department where the eligible pensioner last worked shall be required. Such permission may be given when treatment in such a hospital is essential and referred by a recognized hospital. Finance Department may be consulted where necessary. (14) Medical Advance: For major illness like Bypass Surgery, implantation of Pacemaker, Coronary angioplasty with Stenting, Kidney transplantation, etc. medical advance may be sanctioned and it shall only be sanctioned to an eligible Govt. Pensioner if medical attendance and treatment of his/ her or his/ her family members are done in a Government Hospital. The sanctioning authority for reimbursement of the costs of medical attendance and treatment may grant 80 percent of the estimated cost including implants as advance directly to the Govt. hospital. The Sanctioning Authority shall take necessary steps for adjustment of the advance after obtaining Utilization Certificate from the hospital. (15) If any difficulty arises in course of implementation of the West Bengal Health Scheme for the State Government Pensioners it shall be referred to the Finance Department and decision of the Finance Department shall be final. 62 FORM I Application for enrolment [See sub-para (iv) of para-4 of memo no. 3475 F dt. 11.05.09.] To The…………………………………………...................……………… (Pension Sanctioning Authority) Subject: Application for enrolment to the West Bengal Health Scheme, 2008 Dear Sir, I, along with the members of my family whose particulars are given at Sl. No. 10 may please be admitted to the West Bengal Health Scheme,2008 with effect from ……………………………………. My particulars are given 1. Name of the Pensioner 2. Residential Address 3. Date of Retirement/Death 4. Department/Office from where retired 5. Basic Pension(before commutation) 6. Whether in receipt of Family Pension? 7. If yes, name of the Family Pensioner 8. Pension Payment Order No. 9. Last Pay(Band Pay+ Grade Pay) drawn before retirement 10. Details of Family. Sl. No. 1. 2. 3. 4. 5. Name Age Relationship : : : : : : : : : I do hereby declare that upon enrolment under the above scheme I shall forgo the regular medical relief drawn by me as part of pensionary benefits. I further declare that I shall abide by the provisions of the West Bengal Health Scheme, 2008 as may be in force from time to time. Signature of the Applicant 63 FORM II Certificate of enrolment [See sub-para (v) of para-4 of memo no. 3475 F dt. 11.05.09.] Certified that Shri/Smt…………………………......……….Ex…………………......…………………. who was attached to……………………........…………………. (office) under………………………………....……………… Department/ Shri/Smt ……………………………........………………Family Pensioner has been enrolled under the West Bengal Health Scheme,2008, with effect from ………………………… The particulars of the members of his family as defined in para 3(v) of memo no. 3475 F dt.11.05.2009 are as follows. 1. Name of the Government Pensioner 2. Residential Address 3. Date of retirement 4. Pension Payment order no. 5. Last Pay(Band Pay + Grade Pay) drawn before retirement 6. Basic Pension(before commutation) Details of Family : Sl. No. 1. 2. 3. 4. 5. Name Age Relationship Monthly income, (if any) : : : : : : Signature of the Cadre Controlling Authority/Head of the Office/ Pension Sanctioning Authority Copy forwarded for information and necessary action to : 1. Shri/ Smt …………..........................…………………………………………………………. (Ex. .................) 2. The Treasury Officer ….........……..............……………………… Treasury……………………..………….... ...................……………………………………… (address). He is requested to discontinue the drawal of regular medical allowance in respect of Shri/ Smt. ......………………………………… with effect from………………………………… 64 FORM III Application Form for settlement of claim for reimbursement. [See sub-para (i) of para 11 of memo no. 3475 F dt. 11.05.09.] (To be filled in by the applicant) 1. Identity Card (meant for the Scheme) No. : : : : 2. Full name of Govt. Pensioner / Family Pensioner with designation (in Block letters ) 3. Full Address : (i) Office (from where retired) (ii) Residence 4. Name of the patient & relationship With the Govt. Pensioner 5. Last Pay Drawn ( Band Pay + Grade Pay ) / Basic Pension before Commutation 6. Name of the Hospital with address and Code number a. b. OPD treatment and investigation Indoor treatment and investigation : : 7. Date of admission : ............................................ Date of discharge .......................................... (in case of indoor treatment only) 8. Total amount claimed a. b. OPD treatment Indoor treatment : : : : Declaration I hereby declare that the statements made in the application are true to the best of my knowledge and belief and the person for whom medical expenses were incurred is wholly dependent on me. I am a beneficiary of the West Bengal Health Scheme, 2008, and card issued under the scheme was valid at the time of treatment. I agree for the reimbursement as is admissible under the rules. 9. Details of permission 10. Details of Medical advance, if any Date : Signature of Govt. Pensioner/Family Pensioner 65 FORM IV Essentiality Certificate-cum-Statement of Expenditure Certified by Treating Specialist [See sub-para (ii) of para 11 of the memo no. 3475 F dt. 11.05.09.] (to be submitted in duplicate) (Strike out whichever is not applicable) 1. Name of the patient and relationship With Govt. Pensioner 2. Details of expenditure (A) OPD Treatment (I) Name of the Hospital with Code number (II) Total No. of vouchers (III) Amount claimed : : Diagnosis : : : against (Indicate serial number of individual vouchers with name and address of the shops with date each sub-heading in a separate annexure wherever required) Amount Claimed (a) Medicine (b) Consultation fee (Specify number of Consultations) (c) Laboratory charges (Break-up in a separate annexure) (d) Disposable surgical Sundries (e) Special devices like hearing aid/artificial appliances etc. (specify) (f) Miscellaneous (specify) Total: (B) Indoor Treatmen (To be marked N.A. wherever necessary) (Details of Hospital Bill and other vouchers pertaining to the period of indoor treatment) (a) Name of the Hospital with address and Code number (b) Period of Bill From…………………To………………… : : Diagnosis …..…………….......... …..…………….......... …..…………….......... Amount admissible (for official use) …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... 66 (c) Amount claimed (indicate serial number of individual vouchers with name and address of shops with date against each sub-heading in a separate annexure wherever required) Amount Claimed Amount admissible (for official use) : …..…………….......... (i) Room Rent (ICU/ICCU/Ward) …..…………….......... From……………To…………….. (ii) Charges for : (a) O.T. (b) O.T. Consumables (c) Anesthesia (d) Procedure (iii) Medicines …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... (iv) Implants like pacemaker, …..…………….......... Joint Replacement, coronary stent etc. (details) (v) Artificial devices (details) (vi) Lab Charges (Break-Up give n in Annexure) (vii) Spl. Nurse/Ayah, if any (viii) Miscellaneous Total: …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... …..…………….......... (Signature of Claimant) Name in Block Letters Address: 67 1. Certified that the relevant bills/vouchers have been verified by me and the expenditure shown above is correct and the treatment services provided are essential and minimum that required for the recovery of the patient. 2. Certified that the services of Special Nurse/Ayah were required from…….....…………to………………… that were absolutely essential for the recovery of the patient. 3. Specific procedure/Operation performed was…………………………………......................…………… (Signature of the Treating Specialist with official seal) Countersigned by Medical Superintendent Of the Hospital with seal (For Indoor treatment only) 68 FORM V Checklist For Reimbursement Of Medical Claims [See sub-para (ii) of para 11 of memo no. 3475 F dt. 11.05.09.] 1. Card No. and place of issue 2. Entitlement Private/Semi-Private/General ward 3. Full name of Govt. Pensioner/ Family Pensioner (block letters) 4. Designation 5. The following documents are submitted (please tick ( ) the relevant column) (a) Photocopy of the identity (b) Essential Certificate (c) Number of original bills (d) Whether original bills/vouchers have been verified (e) Copy of discharge summery (f) Copy of permission letter (g) Whether the hospital has given break up for lab investigations (h) Original papers have been lost the following documents are submitted (I) Photocopies of claim paper (II) Affidavit on stamp paper (i) In case of death of card-holder the following documents are submitted (I) Affidavit on stamp paper by claimant (II) No objection from the legal heirs on stamp papers (III) Copy of death certificate : : : : : : : : : : : : Yes/No. Yes/No. Yes/No. Yes/No. Yes/No. Yes/No. : : : : : : : Yes/No. Yes/No. Yes/No. Yes/No Yes/No. Dated : …………………………… Signature of the Applicant 69 FORM VI Temporary Family Permit [ See sub-para (vii) of para- 7 of memo no. 3475 F dt. 11.05.09.] 1. Name of the Govt. Pensioner/family pensioner 2. Employee code No. (P.P.O. No.) 3. Designation 4. Last Pay (Band Pay + Grade Pay)/Basic Pension 5. Entitlement of accommodation 6. Date of Birth 7. Date of retirement/death 8. Residential address 9. Details of Family Sl. No. 1. 2. 3. 4. 5. Shri/Smt……………..............................……………last attached to ………............………………(office) under …………………...............…………..Department has been enrolled under the West Bengal Health Scheme, 2008 with effect from…………………..........................………. He/ She and his/ her family members are entitled to the medical attendance and treatment in a Govt. Hospital/ enlisted Pvt. Hospital or Institution etc. in the entitled class mentioned in SI. No. 5. This permit is valid for 6 (six) months from the date of issue. Signature of Pension Sanctioning Authority By order of the Governor, Name Age Relationship : : : : : : : : : Monthly income,( if any) D. MUKHOPADHYAY, Principal Secy. to the Govt. of West Bengal. 70 Annexure - C MEMORANDUM OF AGREEMENT (MOA) GOVERNMENT OF WEST BENGAL FINANCE DEPARTMENT ALL THE HOSPITALS / DIAGNOSTIC CENTRES WHICH WILL RENDER SERVICE TO THE BENEFICIARIES UNDER THE WBHS 2008 ARE ADVISED TO PREPARE THE AGREEMENT BETWEEN THE ____________________________ AND THE CONCERNED HOSPITAL / DIAGNOSTIC CENTRE ON A NON-JUDICIAL STAMP PAPER OF RS. 100/- FOR FURTHER NECESSARY ACTION. 71 Annexure - C AGREEMENT This Agreement is made on the __________ day of ___________, ___________ between the Governor of West Bengal acting through West Bengal Health Scheme 2008, Government of West Bengal having its office at ___________________(hereinafter called WBHS 2008, which expression shall, unless repugnant to the context or meaning thereof, be deemed to mean and include its successors and assigns) of the First Part AND ……………………………………….. (Name of the Hospital / Diagnostic Centre with Address) of the Second Part. WHEREAS the WBHS 2008 is providing comprehensive medical care facilities to the West Bengal Government Employees or Pensioners. AND WHEREAS WBHS 2008 proposes to provide treatment facilities and diagnostic facilities to the beneficiaries in the Private Recognized Hospitals or Diagnostic Centres AND WHEREAS (Name of the Hospital) has offered to give the following treatment or diagnostic facilities to the beneficiaries under the WBHS 2008 in the Hospital or Diagnostic Centre. .................................................................................................................................................................... .................................................................................................................................................................... .................................................................... NOW, THEREFORE, IT IS HEREBY AGREED between the Parties as follows: 72 Annexure - C 1. DEFINITIONS AND INTERPRETATIONS 1.1. The following terms and expressions shall have the following meanings for purposes of this Agreement: 1.1.1. “Agreement” shall mean this Agreement and all Schedules, supplements, appendices, appendages and modifications thereof made in accordance with the terms of this Agreement; 1.1.2. “Card” shall mean a card, issued by any competent authority under the WBHS 2008 , 1.1.3. “Card Holder” shall mean a person having a card under the WBHS 2008; 1.1.4. “WBHS 2008 beneficiary” shall mean a person who is eligible for coverage of WBHS 2008 and hold a valid card for the benefit under the WBHS 2008; 1.1.5. “emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the early convenience, be detrimental to the health of the patient or will jeopardize the life of the patient; 1.1.6. “Hospital” shall mean the (Name of the Hospital) while performing under this Agreement providing medical investigation, treatment and the healthcare of human beings; 1.1.7. “Package rate” shall mean and include lump sum cost of inpatient treatment / day care / diagnostic procedure for which a beneficiary under the WBHS 2008 has been permitted by the competent authority or for treatment under emergency from the time of admission to the time of discharge including (but not limited to) – (i) Registration charges, (ii) Admission charges, (iii) Accommodation charges including patients diet, (iv) Operation charges, (v) Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit charges, (viii) ICU / ICCU charges, (ix) Monitoring charges, (x) Transfusion charges, (xi) Anaesthesia charges, (xii) Operation theatre charges, (xiii) Procedural charges / surgeon’s fee, (xiv) Cost of surgical disposables and all sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges etc; and (xviii) Nursing care and charges for its services but excluding expenses on telephone, tonics, toiletries, cosmetics etc. 1.2. Annexure-I, consisting of the rate schedule for different packages, procedures and investigations shall be deemed to be an integral part of this Agreement. 1.3. Annexure –II having the proforma for the performance bank guarantee & required guarantee 2. CHARGES FOR SERVICE RENDERED 2.1 The Hospital / Diagnostic Centre shall charge from the beneficiary under the WBHS 2008 as per the rates for a particular procedure / package deal as prescribed by the WBHS 2008 and attached as Annexure 1(rate list), which shall be an integral part of this Agreement. The charges for services rendered shall be computed as 100% of rates for Class 1 Hospitals and Diagnostic Centres, 80 % of rates for Class 2 Hospitals and Diagnostic Centres and 70% of rates for Class 3 Hospitals and Diagnostic Centres. 2.2 73 Annexure - C 2.3 For surgical cases/ packages, where there are no WBHS 2008 prescribed rates, charges for services shall be arrived at by calculating admissible amount item-wise (e.g. room rent, investigations, cost of medicines, procedure charges based on similar types of cases etc) as per approved rates/ actual expenditure. For medical conditions where no package is possible, charges for services shall be arrived at by calculating admissible amount item-wise (e.g. room rent, investigations, cost of medicines, procedure charges etc) as per approved rates/ actual expenditure, in case of investigations/ medicines. The rates as given in Annexure I shall be the maximum rate and such rate may be charged from a Beneficiary under the WBHS 2008, for a particular service rendered. However, the rate being charged shall not be more than what is being charged for same procedure/ facility from other (non-WBHS 2008) patients or institutions. An authenticated list of rates being charged from any person other than beneficiaries shall be displayed in the hospital in conformity with the West Bengal Clinical Establishment Rules 2003. Any additional charges, if paid by a beneficiary under the WBHS 2008, shall have to be refunded if detected subsequently. 2.4 2.5 3. CLASSIFICATION OF HOSPITALS/ DIAGNOSTIC CENTRES 3.1. The classification of the Hospitals/ Diagnostic centres shall be based on their meeting the empanelment criteria as determined by the Finance Department and the Health and Family Welfare Department. The decision of the Authority under the WBHS 2008 shall be final and binding in this respect. 3.2. If reclassification is requested after addition of facilities, a fresh application with assessment fees shall be submitted. 3.3. The rates to be charged from the beneficiaries shall be as follows:3.3.1. Class 1 provider- 100% of approved rates, as given in Annexure 1; 3.3.2. Class 2 provider- 80% of approved rates, as given in Annexure 1; 3.3.3. Class 3 provider- 70% of approved rates, as given in Annexure 1; 4. DURATION 4.1. The Agreement shall remain in force for a period of 2 years or till it is modified or revoked, whichever is earlier. The Agreement may be extended for subsequent periods as required by WBHS 2008, subject to fulfilment of all the terms and conditions of this Agreement and with mutual consent. 74 Annexure - C 5. MEDICAL AUDIT OF BILLS 5.1. The medical audit/ prescription audit of the bills of the Hospital / Diagnostic Centre shall be conducted by the WBHS 2008 or any authority designated by WBHS 2008 for that purpose, within 90 days of discharge of the beneficiary under the WBHS 2008 from Hospital or the date of diagnostic investigation. If any overpayment made by the beneficiary under the WBHS 2008 is subsequently detected, the same shall be refunded by the Hospital/ Diagnostic Centre to the beneficiary within 15 days of such refund being claimed by the beneficiary. 6. VALIDITY OF RATES 6.1. The rates shall remain valid for two years from the date of signing of the Agreement. 7. TREATMENT IN EMERGENCYAND PRIORITY IN ADMISSION 7.1. In emergency, the Hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing facilities under the WBHS 2008 scheme, on production of a valid card issued by the competent authority under the said scheme. The final bill shall be settled by the patient prior to discharge. 7.2. If a Hospital refuses to provide the treatment to bonafide beneficiaries under the WBHS 2008 in emergency cases, without valid ground, such a hospital shall be disqualified for continuation of empanelment. 7.3. Normally, the treatment in higher category of accommodation than the entitled category shall not be permissible. However, in case of emergency when the entitled category accommodation is not available, admission in the immediate higher category may be allowed till the entitled category accommodation becomes available. However, if a particular hospital does not have the ward as per entitlement of the beneficiary, the Hospital may only make bill as per the entitlement of the beneficiary even though the treatment was given in a higher type of ward. 7.4. If, on the request of the beneficiary, treatment is provided in a higher category of ward than that the beneficiary is entitled to, the expenditure over and above the entitlement shall be borne by the beneficiary and it shall be shown separately. 7.5. In non- emergency cases, priority shall be given for the beneficiaries under the WBHS 2008 to get admission and treatment. Non availability of beds shall not be a ground for not providing services to a beneficiary under the WBHS 2008. 75 Annexure - C 8. GENERAL CONDITIONS 8.1. All investigations regarding fitness for the surgery shall be done prior to the admission for any elective procedure and are part of package. 8.2. The package rate has been calculated as per the duration of stay usually required. No additional charge on account of extended period of stay shall be allowed if that extension is due to infection/ complication as a consequence of surgical procedure undertaken or due to any improper procedure/ case management and is not justified. 8.3. The Hospital / Diagnostic Centre shall submit all the medical records to the beneficiary without requiring any additional payment. 8.4. Any legal liability arising due to any default or negligence in providing or performance of the medical services shall be borne exclusively by the Hospital / Diagnostic Centre who shall alone be responsible for the defect and / or deficiencies in rendering such services. 8.5. During the In-patient treatment of the beneficiary under the WBHS 2008, the Hospital shall not ask the beneficiary or his attendant to purchase separately any medicines / sundries / equipment or accessories from outside and shall provide the treatment within the package deal rate, fixed under the WBHS 2008 which includes the cost of all the items. Any such excess payments shall have to be refunded to the Beneficiary under the WBHS 2008 if detected later on. 8.6. During the In-patient treatment of the beneficiary under the WBHS 2008, the Hospital shall not ask the beneficiary or his attendant to pay the consultation fees for any doctor as this shall be provided within the package deal fixed by the WBHS 2008. Any such excess payments shall be refunded to the beneficiary under the WBHS 2008 if detected later on. For any non package services, the consultation fees for all consultation shall be as per the prescribed rates in Annexure I. 8.7. If there is any change in the location, the Hospital/ Diagnostic Centre shall immediately communicate to The Authority under the WBHS 2008. The empanelment shall be temporarily withheld in case of shifting of the facility to any other location without prior permission of the Authority under the WBHS 2008. The new establishment of the same Hospital / Diagnostic Centre shall attract a fresh inspection, at the prescribed fee, for consideration of continuation of empanelment. 8.8. The Hospital / Diagnostic Centre shall submit an annual report in Form No V and VI as per the West Bengal Clinical Establishment Rules 2003 to the licensing authority. 8.9. The Hospital / Diagnostic Centre shall submit a report of services rendered each month in prescribed format to the Secretary, Finance Department within 15 days of the next month in the following proforma:— Abstract of services rendered by a Health Care Organisation empanelled under the WBHS 76 Annexure - C Empanelment No. of the HCO Name of the HCO Address Date of last report submitted Reporting month Sl. Name of No. beneficiary WBHS Identity Card No 3 Whether serving employee or pensioner 4 Name the of Office 5 Description of procedure / tests performed 6 Amount charged Remarks 1 2 7 8 A nil report shall be submitted if no beneficiaries have been treated during a month. Non submission of the report, habitual late submission or submission of incorrect data in the report shall make the HCO liable to be removed from the empanelment under the WBHS. 8.10. Authorized signatory / representative of the Hospital / Diagnostic Centre shall attend the periodic meetings held by Officials connected with the implementation of the WBHS 2008, required in connection with improvement of working conditions. 8.11. During the visit by Officials connected with the implementation of the WBHS 2008 / concerned Department, the Hospital authorities shall cooperate in carrying out the inspection. 8.12. In case of any natural disaster / epidemic, the Hospital / Diagnostic Centre shall fully cooperate with the Health and Family Welfare Department / Director of Health Services, Officials connected with the implementation of the WBHS 2008 and shall convey / reveal all the required information, apart from providing treatment. 8.13. The Hospital / Diagnostic Centre shall not make any commercial publicity projecting the name of WBHS 2008 / Health and Family Welfare Department or Government of West Bengal. However, the fact of empanelment under WBHS 2008 shall be displayed at the premises of the empanelled Centre, indicating that the charges shall be as per WBHS 2008 approved rates. 8.14. The Hospital shall not undertake treatment of referred cases in specialities for which it is not equipped, but shall provide necessary treatment to stabilize the patient and transport the patient safely to nearest Hospital having the necessary facilities. However, in such cases the Hospital shall charge as per the WBHS 2008 rates only for the treatment provided. 9. DUTIES AND RESPONSIBILITIES OF HOSPITALS / DIAGNOSTIC CENTRES 9.1. It shall be the duty and responsibility of the Hospital / Diagnostic Centre, at all times, to obtain, maintain and sustain the valid registration, recognition and high quality and standard of its services and healthcare and to have all statutory / mandatory licenses, permits or approvals of the concerned authorities under or as per the existing laws. 77 Annexure - C 9.2. The Hospital shall keep in its s ervice adequate number of specialists/ consultants of different specialties, so that the beneficiaries under the WBHS 2008 shall be able to obtain the best possible treatment. 9.3. If facility for Diagnostic Centre is not available with the Hospital where the beneficiary is currently admitted, all diagnostic testing shall be sent only to empanelled Diagnostic Centres. 9.4. The Hospital / Diagnostic Centre shall not assign, in whole or in part, its obligations to perform under the agreement, except with the prior written consent of the Authority of the WBHS 2008 at its sole discretions and on such terms and conditions as deemed fit under the WBHS 2008. Any such assignment shall not relieve the Hospital / Diagnostic Centre from any liability or obligation under this Agreement. 9.5. The Hospital / Diagnostic Centre shall be responsible for and obliged to provide all the services in accordance with the Agreement using state-of-the-art methods and economic principles and exercising all means available to achieve the level of performance specified in the Agreement. 9.6. All treatment/ services offered shall be evidence based and treatment modalities shall be in agreement with current medical and ethical practices. 9.7. Specialist treatment shall be provided only by those having the requisite training and competence. Diagnostic reports shall be signed only by those having the necessary specialization. 9.8. Informed consent shall be taken for all high risk procedures. 9.9. The Hospital / Diagnostic Centre shall be obliged to act within its own authority and abide by the directives issued by the Authority under the WBHS 2008. The Hospital / Diagnostic Centre shall be responsible for managing the activities of its personnel and shall hold itself responsible for their misdemeanours, negligence, misconduct or deficiency in services, if any. 10. PERFORMANCE BANK GUARANTEE 10.1. The Hospital / Diagnostic Centre shall furnish a continuous, revolving and irrevocable Performance Bank Guarantee from a nationalized Bank for an amount of Rs. …. (…………………) valid for a period of 05 years in the prescribed proforma to ensure due performance under this Agreement and for efficient service and to safeguard against any default. In case of any violation of the provisions of the Agreement, the provisions of Liquidated Damages as mentioned in Clause 11 below shall be applicable. 11. LIQUIDATED DAMAGES 11.1. The Hospital / Diagnostic Centre shall provide the services as per the requirements specified by the WBHS 2008 in terms of the provisions of this Agreement. In case of initial violation of the provisions of the Agreement by the Hospital / Diagnostic Centre such as refusal of service or direct charging from the beneficiaries under the WBHS 2008 of rates in excess of agreed rates, irrational treatment 78 Annexure - C or use of unnecessary drugs/ medicines/ procedures or defective service and negligence, false billing, the amount equivalent to 15% of the amount of Performance Bank Guarantee shall be charged as agreed Liquidated Damages under the WBHS 2008. However, the total amount of the Performance Bank Guarantee shall be maintained intact being a revolving Guarantee. 11.2. In case of repeated defaults by the Hospital / Diagnostic Centre, the total amount of Performance Bank Guarantee shall be forfeited and action shall be taken by way of removing the Hospital / Diagnostic Centre from the empanelment of WBHS 2008 as well as termination of this Agreement 11.3. In the first instance, the complaint shall be examined by the WBHS 2008 authorities and if the complaint is found to be true the Authority under the WBHS 2008 shall have the right to give a show cause notice to the Hospital to be replied by it within 10 days of its receipt, and the reply of the Hospital shall be examined by a Standing Committee constituted for the purpose of deciding the appropriateness of the treatment or Diagnostic procedures, as the case may be. If the Committee concludes that the Hospital / Diagnostic Centre has violated the provisions of the Agreement necessary action shall be taken for de-empanelment of that Hospital. The decision of the Authority under the WBHS 2008 shall be final. 11.4. For over-billing and unnecessary procedures, the extra amount so charged shall be reimbursed to the beneficiary by the Hospital within 15 days of such claims being found correct by the Standing Committee and the Authority under the WBHS 2008 shall have the right to issue a written warning to the Hospital / Diagnostic Centre not to do so in future. The recurrence, if any, shall lead to the de empanelment to that Hospital / Diagnostic Centre. 12. TERMINATION FOR DEFAULT 12.1. The Authority under the WBHS 2008 may, without prejudice to any other remedy for breach of Agreement, by written notice of default sent to the Hospital / Diagnostic Centre terminate the Agreement in whole or part in any of the following grounds: 12.1.1. If the Hospital / Diagnostic Centre fails to provide any or all of the services for which it has been empanelled within the period(s) specified in the Agreement, or within any extension thereof if granted by the WBHS 2008 pursuant to Condition of Agreement; or 12.1.2. If the Hospital / Diagnostic Centre fails to perform any other obligation(s) under the Agreement; or 12.1.3. If the Hospital / Diagnostic Centre, under the WBHS 2008 has engaged in corrupt or fraudulent practices in competing for or in executing the Agreement; or 12.1.4. The Licence under the West Bengal Clinical Establishment Act & Rules 2003 is revoked by the licensing authorities for any reason; or 12.2. If the Hospital / Diagnostic Centre found to be involved in or associated with any unethical, illegal or unlawful activities, the Agreement shall be summarily suspended by the Authority under the WBHS 2008 without any notice and thereafter may terminate the Agreement, after giving a show cause notice and considering its reply if any, received within 10 days of the receipt of show cause notice; or 79 Annexure - C 12.3. In case of any violation of the provisions of the Agreement by the Hospital / Diagnostic Centre such as (but not limited to), refusal of service, refusal of credit facilities to eligible beneficiaries and direct charging from the beneficiaries under the WBHS 2008 in excess of approved rates, undertaking unnecessary procedures, prescribing unnecessary drugs / tests, deficient or defective service, over billing and negligence in treatment, the Authority under the WBHS 2008 shall have the right to deempanel the Hospital / Diagnostic Centre as the case may be. 13. INDEMNITY 13.1. The Hospital / Diagnostic Centre shall at all times, indemnify and keep indemnified the Authority under the WBHS 2008 / the Government against all actions, suits, claims and demands brought or made against it in respect of anything done or purported to be done by the Hospital / Diagnostic Centre in execution of or in connection with the services under this Agreement and against any loss or damage to WBHS 2008 / the Government in consequence to any action or suit being brought against the WBHS 2008 / the Government, along with (or otherwise), Hospital / Diagnostic Centre as a Party for anything done or purported to be done in the course of the execution of this Agreement. 13.2. The Hospital / Diagnostic Centre shall at all times abide by the job safety measures and other statutory requirements prevalent in India and shall keep free and indemnify the Authority under the WBHS 2008 from all demands or responsibilities arising from accidents or loss of life, the cause or result of which is the Hospital’s / Diagnostic Centre’s negligence or misconduct. 13.3. The Hospital / Diagnostic Centre shall pay all indemnities arising from such incidents without any extra cost to WBHS 2008 and shall not hold the authority under the WBHS 2008 responsible or obligated. The authority under the WBHS 2008 / the Government may, at its discretion and shall always entirely at the cost of the Hospital / Diagnostic Centre, defend such suit, either jointly with the Hospital / Diagnostic Centre or singly in case the latter chooses not to defend the case. 14. PAYMENT 14.1. The payment shall be made to the Hospital / Diagnostic Centre by the beneficiary directly. All bills and papers related to the beneficiaries’ treatment shall be handed over in original along with the necessary counter signatures by the authorised persons. 14.2. On admission of the beneficiary, a written estimate of the expected bill shall be handed over. Whenever there is a change of setting requiring the escalation of this estimate, a fresh estimate shall be given to the patient/ patient party within 24 hours. 80 Annexure - C 15. ARBITRATION 15.1. If any dispute or difference of any kind whatsoever (the decision whereof is not herein otherwise provided for) shall arise between the Authority of the WBHS 2008 and the Hospital / Diagnostic Centre upon or in relation to or in connection with or arising out of the Agreement, shall be referred to for arbitration by the Director of Medical Education, West Bengal, who shall give written award of his decision to the Parties. The decision of the Director of Medical Education, West Bengal shall be final and binding. The provisions of the Arbitration and Conciliation Act, 1996 (26 of 1996) shall apply to the arbitration proceedings. The venue of the arbitration proceedings shall be at Kolkata. 16. MISCELLANEOUS 16.1. Nothing under this Agreement shall be construed as establishing or creating between the Parties any relationship of Master and Servant or Principal and Agent between the Authority under the WBHS 2008 and the Hospital / Diagnostic Centre. 16.2. The Hospital / Diagnostic Centre shall not represent or hold itself out as agent of the authority under the WBHS 2008. 16.3. The authority under the WBHS 2008 shall not be responsible in any way for any negligence or misconduct of the Hospital / Diagnostic Centre and its employees for any accident, injury or damage sustained or suffered by any Beneficiary under the WBHS 2008 or any third party resulting from or by any operation conducted by and on behalf of the Hospital / Diagnostic Centre or in the course of doing its work or perform their duties under this Agreement or otherwise. 16.4. The Hospital / Diagnostic Centre shall notify the authority under the WBHS 2008 of any material change in their status and their shareholdings or that of any Guarantor of the Hospital / Diagnostic Centre where such change would have an impact on the performance of obligation under this Agreement. 16.5. This Agreement may be modified or altered only on written agreement signed by both the parties. 16.6. If the Hospital get wound up or partnership is dissolved, the authority under the WBHS 2008 shall have the right to terminate the Agreement. The termination of Agreement shall not relieve the Hospital or their heirs and legal representatives from the liability in respect of the services provided by the Hospital during the period when the Agreement was in force. 16.7. The Hospital shall bear all expenses incidental to the preparation and stamping of this Agreement. 81 Annexure - C 17. NOTICES 17.1. Any notice given by one party to the other pursuant to this Agreement shall be sent to other party in writing by registered post or by facsimile and confirmed by original copy by post to the other Party’s address as below. WBHS 2008 : ___________________________________________. Hospital / Diagnostic Centre with address: (………………………………………………………………………) A notice shall be effective when served or on the notice’s effective date, whichever is later. Registered communication shall be deemed to have been served even if it returned with remarks like refused, left, premises locked, etc. 82 Annexure - C IN WITNESSES WHEREOF, the parties have caused this Agreement to be signed and executed on the day, month and the year first above mentioned. Signed by For and on behalf of The Governor of West Bengal In the Presence of (Witnesses) 1. 2. Signed by For and on behalf of (Hospital / Diagnostic Centre) Duly authorized vide Resolution No. ……… dated ……. of (name of Hospital / Diagnostic Centre) In the presence of (Witnesses) 1. 2. 83 Annexure - C Annexure - II Performance Bank Guarantee To: WHEREAS _______________________________________________________________(Name of Hospital / Diagnostic Centre) has undertaken, Agreement No. ______________ ________________________ dated, ______________________ to ________ ___________ _________ _______________________ (Description of Services) hereinafter called “the Agreement”. AND WHEREAS it has been stipulated by you in the said Agreement that the Hospital / Diagnostic Centre selected for empanelment shall furnish you with a bank Guarantee by a nationalized bank for the sum specified therein as security for compliance with the Hospital / Diagnostic Centre performance obligations in accordance with the Agreement. AND WHEREAS we have agreed to give the Hospital / Diagnostic Centre a guarantee: Now, THEREFORE, we hereby affirm that we are Guarantors and responsible to you, on behalf of Hospital / Diagnostic Centre (herein after referred to “the Second Part,” up to a total of _________________________________(Amount of the guarantee in Words and Figures) and we hereby irrevocably, unconditionally and absolutely undertake to immediately pay you, upon your first written demand declaring the Second Part to be in default under the Agreement and without cavil or argument, any sum or sums within the limit of ___________________________ as aforesaid, without your needing to prove or to show this grounds or reasons for your demand or the sum specified therein. This guarantee is valid until the ___________ day of ______________ 2013. Signature and Seal of Guarantors _________________________________ _________________________________ Date _________________________________ Address: _________________________________ 84 Annexure - C Amount of Performance Bank Guarantee to be obtained from the Hospital / Diagnostic Centres at the time of signing the Agreement :— Multi specialty Hospitals All other HCOs Rs. 25.00 thousand Rs. 10.00 thousand